The structure and regulation of family practice residency laboratories

Increasing regulation of physician office laboratories (POLs), increased complexity of outpatient care, and technological advances have increased the need to train family practice residents in POL management. There is little information on how residency laboratories are organized, how they are regulated, and how often quality controls and proficiency testing are done.

A questionnaire was sent to 385 ACGME-approved family practice residencies to determine the scope of testing, quality-assurance activities, and administrative structure of the residency laboratory.

Two hundred and ninety-seven programs responded, for a response rate of 77%; 91.6% were performing routine office tests and 40.7% were performing automated testing. Of programs that performed automated tests, 71.2% were performing daily normal and abnormal quality-control specimens. Proficiency testing was only performed by 57.8% of programs. The program's parent hospital viewed the residency laboratory as a POL in 55.6% of cases and as a satellite of the hospital laboratory in 32.6%.

Residency laboratories are more frequently organized as POLs than satellite laboratories of the parent hospitals. The POL model offers an excellent opportunity to teach residents about office laboratory management. Residency laboratories should be implementing proficiency testing for both patient safety and resident teaching. Many residency laboratories will need to increase the frequency of quality controls as the new CLIA '88 regulations are implemented. Accreditation by a private organization may be an attractive option for family practice office laboratories.