AHRQ Patient Safety Network

The Collection > Laboratory Result Tracking Improvement

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•Diagnostic Errors (19)

•Identification Errors (16)

•Discontinuities, Gaps, and Hand-Off Problems (62)

•Medication Safety (22)

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•Epidemiology of Errors and Adverse Events (16)

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Approach to Improving Safety
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Laboratory Result Tracking Improvement

Clinical Areas

•Medicine (72)

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Target Audience

•Health Care Providers (64)

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Setting of Care

•Hospitals (34)

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REVIEW

Patient safety and error reduction in surgical pathology.

Nakhleh RE. Arch Pathol Lab Med. 2008;132:181-185.

STUDY

Medical errors arising from outsourcing laboratory and radiology services.

Chasin BS, Elliott SP, Klotz SA. Am J Med. 2007;120:819.e9-11.

STUDY

Patient safety in the clinical laboratory: a longitudinal analysis of specimen identification errors.

Wagar EA, Tamashiro L, Yasin B, Hilborne L, Bruckner DA. Arch Pathol Lab Med. 2006;130:1662-1668.

STUDY

Decreasing mislabeled laboratory specimens using barcode technology and bedside printers.

Brown JE, Smith N, Sherfy BR. J Nurs Care Qual. 2011;26:13-21.

COMMENTARY classic

Errors in laboratory medicine: practical lessons to improve patient safety.

Howanitz PJ. Arch Pathol Lab Med. 2005;129:1252-1261.

NEWSLETTER/JOURNAL

Laboratory Errors & Patient Safety.

Seattle, WA: Medical Training Solutions.

NEWSPAPER/MAGAZINE ARTICLE

Follow-up tips for a safe, efficient practice.

Weiss GG. Med Econ. May 19, 2006; 83:47-49.

REVIEW

The safety implications of missed test results for hospitalised patients: a systematic review.

Callen J, Georgiou A, Li J, Westbrook JI. BMJ Qual Saf 2011;20:194-199.

STUDY

Computer-assisted bar-coding system significantly reduces clinical laboratory specimen identification errors in a pediatric oncology hospital.

Hayden RT, Patterson DJ, Jay DW, et al. J Pediatr. 2008;152:219-224.

STUDY

Communication outcomes of critical imaging results in a computerized notification system.

Singh H, Arora HS, Vij MS, Rao R, Khan MM, Petersen LA. J Am Med Inform Assoc. 2007;14:459-466.

REVIEW

Identifying cross contaminants and specimen mix-ups in surgical pathology.

Hunt JL. Adv Anat Pathol. 2008;15:211-217.

COMMENTARY

Putting power into patient safety: interventions.

Astion M. Laboratory Errors & Patient Safety. May-June 2005;1:5-8.

STUDY

The value of inking breast cores to reduce specimen mix-up.

Renshaw AA, Kish R, Gould EW. Am J Clin Pathol. February 2007;127:1-2.

STUDY

Patient safety concerns arising from test results that return after hospital discharge.

Roy CL, Poon EG, Karson AS, et al. Ann Intern Med. 2005;143:121-128.

TOOLKIT

Communicating Critical Test Results.

Burlington, MA: Massachusetts Coalition for the Prevention of Medical Errors; 2003.

STUDY

The frequency of missed test results and associated treatment delays in a highly computerized health system.

Wahls TL, Cram PM. BMC Fam Pract. 2007;8:32.

STUDY

Outpatient adverse drug events identified by screening electronic health records.

Gandhi TK, Seger AC, Overhage JM, et al. J Patient Saf. 2010;6;91-96.

STUDY

Classifying laboratory incident reports to identify problems that jeopardize patient safety.

Astion ML, Shojania KG, Hamill TR, Kim S, Ng VL. Am J Clin Pathol. 2003;120:18-26.

NEWSPAPER/MAGAZINE ARTICLE

Lost surgical specimens, lost opportunities.

PA-PSRS Patient Saf Advis. September 2005;2:1-5.

NEWSPAPER/MAGAZINE ARTICLE

Entire UPMC transplant team missed hepatitis alert.

Hamill SD. Pittsburgh Post-Gazette. July 10, 2011:A6.

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