在初级保健中执行和传达血液检测结果的患者安全：使用初级保健学术合作（PACT）进行的英国范围的审计。

Patient safety in actioning and communicating blood test results in primary care: a UK wide audit using the Primary care Academic CollaboraTive (PACT).

机构信息

Population Health Sciences, University of Bristol, Bristol, UK

Population Health Sciences, University of Bristol, Bristol, UK.

出版信息

BMJ Open Qual. 2024 Jul 25;13(3):e002632. doi: 10.1136/bmjoq-2023-002632.

DOI:10.1136/bmjoq-2023-002632

PMID:39059792

Abstract

BACKGROUND

Errors associated with failures in filing, actioning and communicating blood test results can lead to delayed and missed diagnoses and patient harm. This study aimed to audit how blood tests in primary care are filed, actioned and communicated in primary care, to identify areas for patient safety improvements.

METHODS

UK primary care clinicians were recruited through the Primary Care Academic CollaboraTive (PACT). PACT members audited 50 recent sets of blood tests from their practice and retrospectively extracted data on blood test result coding, actioning and communication. PACT members received a practice report, showing their own results, benchmarked against other participating practices.

RESULTS

PACT members from 57 general practices across all four UK nations collected data on 2572 patients who had blood tests in April 2021. In 89.9% (n=2311) they agreed with the initial clinician's actioning of blood tests; 10.1% disagreed, either partially (7.1%) or fully (3.0%).In 44% of patients (n=1132) an action (eg, 'make an appointment') was specified by the filing clinician. This action was carried out in 89.7% (n=1015/1132) of cases; in 6.8% (n=77) the action was not carried out, in 3.5% (n=40) it was unclear. In the 117 cases where the test result had not been actioned 38% (n=45) were felt to be at low risk of harm, 1.7% (n=2) were at high risk of harm, 0.85% (n=1) came to harm.Overall, in 47% (n=1210) of patients there was no evidence in the electronic health records that results had been communicated. Out of 1176 patients with one or more abnormal results there was no evidence of test communication in 30.6% (n=360). There were large variations between practices in rates of actioning and communicating tests.

CONCLUSION

This research demonstrates variation in the way blood test results are actioned and communicated, with important patient safety implications.

摘要

背景

与文件归档、执行和沟通血液检测结果相关的错误可能导致诊断延迟和漏诊，以及患者受到伤害。本研究旨在审核初级保健中血液检测的归档、执行和沟通情况，以确定患者安全改进的领域。

方法

通过初级保健学术合作组织（PACT）招募英国初级保健临床医生。PACT 成员审核了他们实践中的 50 套最近的血液检测结果，并回顾性地提取了血液检测结果编码、执行和沟通的数据。PACT 成员收到了一份实践报告，显示了他们自己的结果，并与其他参与实践进行了基准比较。

结果

来自英国四个国家的 57 家全科诊所的 PACT 成员收集了 2021 年 4 月接受血液检测的 2572 名患者的数据。在 89.9%（n=2311）的患者中，他们同意初始临床医生对血液检测的处理；10.1%（n=251）部分（7.1%）或完全（3.0%）不同意。在 44%的患者（n=1132）中，归档临床医生指定了一项行动（例如，“预约”）。在 89.7%（n=1015/1132）的情况下执行了该行动；在 6.8%（n=77）的情况下未执行该行动，在 3.5%（n=40）的情况下不清楚是否执行了该行动。在 117 例未处理检测结果的情况下，38%（n=45）被认为低风险受到伤害，1.7%（n=2）高风险受到伤害，0.85%（n=1）受到伤害。总体而言，在 47%（n=1210）的患者中，电子健康记录中没有证据表明结果已被沟通。在 1176 名有一个或多个异常结果的患者中，有 30.6%（n=360）没有检测结果沟通的证据。在处理和沟通检测结果方面，不同实践之间存在很大差异。