Bowie Paul, Halley Lyn, McKay John
Department of Postgraduate GP Education, NHS Education for Scotland, Glasgow, UK.
BMJ Open. 2014 Feb 6;4(2):e004245. doi: 10.1136/bmjopen-2013-004245.
To explore experiences and perceptions of frontline administrators involved in the systems-based management of laboratory test ordering and results handling in general medical practice.
Qualitative using focus group interviews.
West of Scotland general medical practices in three National Health Service (NHS) territorial board areas.
Convenience samples of administrators (receptionists, healthcare assistants and phlebotomists).
Transcript data were subjected to content analysis.
A total of 40 administrative staff were recruited. Four key themes emerged: (1) system variations and weaknesses (eg, lack of a tracking process is a known risk that needs to be addressed). (2) Doctor to administrator communication (eg, unclear information can lead to emotional impacts and additional workload). (3) Informing patients of test results (eg, levels of anxiety and uncertainty are experienced by administrators influenced by experience and test result outcome) and (4) patient follow-up and confidentiality (eg, maintaining confidentiality in a busy reception area can be challenging). The key findings were explained in terms of sociotechnical systems theory.
The study further confirms the safety-related problems associated with results handling systems and adds to our knowledge of the communication and psychosocial issues that can affect the health and well-being of staff and patients alike. However, opportunities exist for practices to identify barriers to safe care, and plan and implement system improvements to accommodate or mitigate the potential for human error in this complex area.
探讨参与基层医疗实践中实验室检查医嘱及结果处理系统管理的一线管理人员的经验和看法。
采用焦点小组访谈的定性研究。
苏格兰西部三个国民保健服务（NHS）地区委员会辖区内的基层医疗实践机构。
管理人员（接待员、医疗保健助理和采血员）的便利样本。
对转录数据进行内容分析。
共招募了40名行政人员。出现了四个关键主题：（1）系统差异和弱点（例如，缺乏跟踪流程是一个需要解决的已知风险）。（2）医生与管理人员的沟通（例如，信息不明确会导致情绪影响和额外工作量）。（3）告知患者检查结果（例如，管理人员会因经验和检查结果而经历不同程度的焦虑和不确定性）以及（4）患者随访和保密（例如，在繁忙的接待区保持保密可能具有挑战性）。研究结果依据社会技术系统理论进行了解释。
该研究进一步证实了与结果处理系统相关的安全问题，并增加了我们对可能影响工作人员和患者健康与福祉的沟通及心理社会问题的认识。然而，基层医疗实践机构有机会识别安全护理的障碍，并规划和实施系统改进措施，以适应或减轻这一复杂领域中人为错误的可能性。
