Laboratory test ordering and results management systems: a qualitative study of safety risks identified by administrators in general practice

OBJECTIVE: 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. DESIGN: Qualitative using focus group interviews. SETTING: West of Scotland general medical practices in three National Health Service (NHS) territorial board areas. PARTICIPANTS: Convenience samples of administrators (receptionists, healthcare assistants and phlebotomists). METHODS: Transcript data were subjected to content analysis. RESULTS: 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. CONCLUSIONS: 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.