• Douglas Fernald, Mika Hamer, Kathy James, Brandon Tutt, and David West.
• From the Department of Family Medicine, University of Colorado School of Medicine, Aurora (DF, MH, KJ, DW); and the Colorado Health Outcomes Program, University of Colorado School of Medicine, Aurora (MH, BT, DW). doug.fernald@ucdenver.edu.
• J Am Board Fam Med. 2015 Sep 1; 28 (5): 576-83.

IntroductionFamily medicine and internal medicine physicians order diagnostic laboratory tests for nearly one-third of patient encounters in an average week, yet among medical errors in primary care, an estimated 15% to 54% are attributed to laboratory testing processes. From a practice improvement perspective, we (1) describe the need for laboratory testing process quality improvements from the perspective of primary care practices, and (2) describe the approaches and resources needed to implement laboratory testing process quality improvements in practice.MethodsWe applied practice observations, process mapping, and interviews with primary care practices in the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP)-affiliated practice-based research networks that field-tested in 2013 a laboratory testing process improvement toolkit.ResultsFrom the data collected in each of the 22 participating practices, common testing quality issues included, but were not limited to, 3 main testing process steps: laboratory test preparation, test tracking, and patient notification. Three overarching qualitative themes emerged: practices readily acknowledge multiple laboratory testing process problems; practices know that they need help addressing the issues; and practices face challenges with finding patient-centered solutions compatible with practice priorities and available resources.ConclusionWhile practices were able to get started with guidance and a toolkit to improve laboratory testing processes, most did not seem able to achieve their quality improvement aims unassisted. Providing specific guidance tools with practice facilitation or other rapid-cycle quality improvement support may be an effective approach to improve common laboratory testing issues in primary care.© Copyright 2015 by the American Board of Family Medicine.

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