5 potential problems which I have previously encountered, all of which have a significant contribution from GP clinical system behaviour and will be replicated in their display of results.  These are all long standing issues between labs and primary care which we can fix at the laboratory end and try to get the GP to resolve on their system. However the potential impact of this sort of problem will become much more significant when patients get involved.

 

1         I think the collective brain will agree that there is a risk from converting results into different units to those provided by the laboratory (System 1 is a particular problem in this situation. Particularly need to check PTH and other esoteric tests).  The receiving system changes results and the simple reference ranges into their preferred units but cannot convert comments or reference ranges embedded in them (eg LMP related ranges, time post dose ranges etc).

2         Some GP clinical systems hide our carefully crafted comments and complex reference ranges. The GP needs to suspect there is a comment there and go searching rather than having it presented alongside the appropriate result ( Might actually make things safer though as it makes it more unlikely that GPs will do anything inappropriate in response to changed results which are outside un-changed levels mentioned in a comment).  Presumably patients will also have to perform the same if they are to access the explanations.

3         We have experienced issues where GPs have written logic to get results in the right place on their system but they then do the wrong thing when result formats change eg one practice spotted sample type as urine and interpreted all results a pregnancy testing. OK until we started sending microbiology results and they left the logic in so all patients with positive urine cultures were recorded as pregnant!

4         Patient ID can be a bit doubtful due to the lack of near-real time spine connectivity, universal electronic requesting (due in 2005 from what I recall of the launch of NPfIT) and effective checking with the patient at the time of sample collection. Like all laboratories, we regularly get   hand written forms which have a mixture of details from several patients or un-detectable transcription errors.  On occasion in the past  we have manually entered an incorrect NHS number on our system which then went out on printed and electronic reports.  Some GP systems take the incoming NHS number in a message as absolute and merge the result into that record even though none of the rest of the demographics match.  This could result is a significantly concerned patient when they find results on their record which they don’t understand, don’t recall having had done were not theirs.

5         While on patient ID, there are potentially problems at the practice with manual result merging where lab staff would be shocked at the inadequate level of matching which gets accepted.  On one occasion we discovered a result which had been associated with a patient on the basis of gender and date of birth alone, none of the other demographics matched.  The request wasn’t even  from that practice but a wrongly written GP code had directed it to the wrong surgery.

 

Richard Stott

Principal Clinical Scientist  & Pathology Clinical Governance lead.

 

Barking, Havering & Redbridge University Hospitals NHS Trust: Working to make our hospitals better.

This communication, together with any files or attachments transmitted with

it contains information which is confidential and may be subject to legal 

privilege and is intended solely for the use by the person(s) or entity to 

whom it is addressed. If you are not the intended recipient you must not 

copy, distribute, publish or take any action in reliance on it. If you have 

received this communication in error, please notify 

[log in to unmask] and delete it from your computer systems.

Barking, Havering & Redbridge University Hospitals NHS Trust reserves the 

right to monitor all communications for lawful purposes. Receipt of this email 

does not imply consent to use or provide this email address, or any others 

contained therein, to any third party for any purposes. The contents of this

email are protected under international copyright law.

To save energy and paper please print this email only if you really need to. 

_____________________________________________________________________________

This email has been scanned for viruses using antivirus software by 

Barking, Havering & Redbridge University Hospitals NHS Trust. Whilst every

care is taken to avoid the transmission of virus code; please ensure that you 

have up to date virus detection software before opening any E-mail 

messages or attachments 

______________________________________________________________________________

------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/