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Today's Safety NewsWorkplace Health

What caused errors in those lab tests your doctor ordered for you?

Surprising study finds that most mistakes don’t happen in the laboratory

April 21, 2014

chemistryLaboratory testing is indispensable to patient care. Although it accounts for only 2% of U.S. healthcare expenditures, laboratory medicine is critical for accurate diagnosis and treatment planning.

A study by ECRI Institute PSO, a patient safety organization, found that 96 percent of of errors in the laboratory testing process actually occurred outside of the lab, yet, organizations often said that the events they reported originated in the laboratory.

ECRI’s Deep Dive™ analysis focused on the impact of errors in the laboratory testing process on clinical decision making.

 “Strategies to reduce diagnostic errors involving laboratory testing must entail all phases of the laboratory testing process and engage all stakeholders in that process,” says Karen P. Zimmer, MD, MPH, FAAP, medical director, ECRI Institute PSO.

ECRI Institute PSO says the responsibility rests with everyone involved in the total testing process:

  • The provider who orders a laboratory test to aid in the care of a patient and makes decisions based on test findings
  • The individual who collects a specimen
  • The transporter who delivers the specimen to the lab
  • The lab technician who processes the test order and records the test results
  • The individual who ensures test results are available to ordering personnel

“We recommend a hierarchy of error-reduction techniques to improve the total testing process and to enhance patient safety,” adds Zimmer.

The Laboratory Safety PSO Deep Dive findings were published in a report available to all ECRI Institute PSO members and its partner PSO members. It reviews strategies for leadership support, standardizing and simplifying some processes, technology solutions, communication and teamwork, staff education, event reporting and analysis, performance improvement, and patient involvement.

The executive summary of the report is available for free viewing/download. Additional information will be presented in ECRI Institute PSO’s Monthly Brief free e-newsletter; go to www.ecri.org/psobrief to sign up. The full report with toolkit and previous Deep Dives on Health IT and Medication Safety are also available for purchase.

KEYWORDS: health care patient safety

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