Using the Primary Care Academic Collaborative to explore patient safety in actioning and communicating blood test results

Problem

Errors associated with failures in filing, communicating, and actioning blood test results can lead to delayed and missed diagnoses and patient harms. Surveys and qualitative research have demonstrated that most UK general practices rely on patients contacting the practice for their test results, seldom using fail-safe mechanisms.

Approach

This study recruited primary care clinicians from across the UK through the Primary Care Academic Collaborative (PACT). PACT members audited 50 recent sets of blood tests from their own practice and entered data into a REDCap database on the coding, actioning, and communication of blood test results. Participating PACT members received a practice report, showing their own results, benchmarked against other participating practices.

Findings

PACT members from 57 GP practices across all four UK nations collected data on 2572 patients who had blood tests taken in April 2021. When the PACT member reviewed the notes with the benefit of hindsight, in 89.9% of cases (n=2,311) they agreed with the initial GPs actioning of blood tests; 10.1% disagreed, either partially (n=183) or fully (n=78). In 44% of patients (n=1,132) an action was specified by the coding GP (e.g. speak to doctor, repeat test). This action was carried out in 89.7% (n=1,015) of cases; in 6.8% (n=77) the action was not carried out, in 3.5% (n=40) it was not possible to tell from the medical records if the action had been carried out or not. 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=1,210) of cases there was no evidence in the medical records that test results had been communicated to patients. In patients with one or more abnormal test results (n=1,176), there was no evidence of test communication in 30.6% (n=360).In a follow up survey, 58% of PACT members had discussed their practice report in a practice meeting, and 50% had utilized these results for quality improvement, education, or practice learning.

Consequences

This research has important implications for patients and clinicians and demonstrates the importance of ensuring failsafe systems are implemented in primary care to ensure blood tests are actioned and communicated to patients. This study also has important implications for researchers, as it is the first to demonstrate the success of the PACT model, opening up opportunities for future research using this collaborative model. We have shown that PACT members can collect data which requires clinical interpretation of the GP electronic health records. We have also shown that sharing benchmarked results with participating practices can help stimulate quality improvement and could help widen participation in research beyond traditionally ‘research active’ practices.