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Table 3 Test results handling trade-offs

From: The role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in UK general practice

Competency Examples Potential risk
Timely management of results Receptionists allocating results to only the GPs who are present in the practice on that day (practice 2) Does not allow for additional complexities relating to the patient that the GP ordering the test or the patient’s regular GP might use to make a decision on the result
Practice nurse screening of ‘normal’ results prior to distribution of ‘abnormal’ results to GPs to optimise use of GPs’ time (practices 1, 3, 8) Incorporates an additional stage in the results handling process (practice 1). Does not allow for the possibility that a ‘normal’ result may have implications that could be overlooked by the nurse
Generalist receptionists doing results handling work (practices 2, 4, 5, 6, 7) May compromise the quality of results handling due to lack of experience of individual receptionists involved in the routine
Single receptionist amalgamating all results into one generic pile for scanning and workflowing (practices 1, 3) Potential for error due to lack of systemisation despite small numbers of results being processed
High quality management of results Single receptionist initially processing test results (practices 1, 3, 8) Focuses all knowledge of this role into one individual; quality of results processing is potentially compromised if that receptionist is on holiday or off sick
Single receptionist or team of receptionists manually logging all results received prior to scanning (practices 2, 4, 5, 6, 7, 8) Laborious and time-consuming
GP processing the results of tests that they had ordered (practices 1, 3, 5, 6, 7, 8) Delay in the review and actioning of results if the GP is not available or develops a backlog
GP processing either the results of the tests that they had ordered or that of their designated ‘buddy’ (practice 4) Potential for quality of processing to be compromised by relative lack of knowledge of ‘buddy’, plus periods when each buddy has double their usual volume of results to process
Receptionist telephoning patient regarding abnormal result (practices 1, 2, 5, 6, 7, 8) Time-consuming as usually requires multiple attempts
Mixed approach to contacting patient regarding abnormal result combining telephoning and then writing to the patient (practice 3) Potentially time-consuming but incorporates varied approaches to contacting patient that are potentially more effective than a single approach
Receptionist writing to patient regarding abnormal result (practice 4) Uncertainty regarding whether letter has arrived and if patient has read and will act on it, particularly in more deprived areas
GP screening of both ‘normal’ and ‘abnormal’ results as normal results are not always appropriate to file without further action (practices 2, 4, 5, 6, 7, 8) Increased volume of results to process; potentially more time-consuming
Being fair whilst being efficient Receptionist ensuring that all GPs received an equitable allocation of results to process (practices 2, 3) Different GPs process their results in different ways and at different speeds, which can frequently lead to variations in the speed of results processing (if all are distributed evenly) or quality (if individual GPs are allocated a higher number of results than they are adequately able to process)