Outpatient order accuracy. A College of American Pathologists Q-Probes study of requisition order entry accuracy in 660 institutions

Arch Pathol Lab Med. 1999 Dec;123(12):1145-50. doi: 10.5858/1999-123-1145-OOA.

Abstract

Context: Laboratory test order entry errors potentially delay diagnosis, consume resources, and cause patient inconvenience.

Objective: To evaluate the frequency and causes of computer order entry errors in outpatients.

Design: Cross-sectional survey and prospective sample of errors. Participants answered questions about their test order entry policies and practices. They then examined a sample of outpatient requisitions and compared information on the requisition with information entered into the laboratory computer system. Order entry errors were divided into 4 types: tests ordered on the requisition, but not in the computer; tests performed but not ordered on the requisition; physician name discrepancies; and test priority errors.

Participants: Six hundred sixty laboratories enrolled in the College of American Pathologists Q-Probes program.

Main outcome measure: Overall order entry error rate.

Results: A total of 5514 (4.8%) of 114 934 outpatient requisitions were associated with at least 1 order entry error. The median participant reported 1 or more order errors on 6.0% of requisitions; 10% of institutions reported errors with at least 18% of requisitions. Of the 4 specific error types, physician name discrepancies had the highest error rate, and test priority errors the lowest error rate. Four institutional factors were significantly associated with higher overall error rates: orders verbally communicated to the laboratory; no policy requiring laboratory staff to compare a printout or display of ordered tests with the laboratory requisitions to confirm that orders had been entered correctly; failure to monitor the accuracy of outpatient order entry on a regular basis; and a higher percentage of occupied beds (ie, a busier hospital).

Conclusions: Computer order entry errors are common, involving 5% of outpatient requisitions. Laboratories may be able to decrease error rates by regularly monitoring the accuracy of order entry, substituting written and facsimile orders for verbal orders, and instituting a policy in which orders entered into computer systems are routinely rechecked against orders on requisitions.

MeSH terms

  • Ambulatory Care / standards*
  • Clinical Laboratory Information Systems / standards*
  • Cross-Sectional Studies
  • Humans
  • Medical Records Systems, Computerized / standards*
  • Pathology
  • Prospective Studies
  • Quality Assurance, Health Care*
  • Societies, Medical
  • Surveys and Questionnaires
  • United States