Patient satisfaction with point-of-care laboratory testing: Report of a quality improvement program in an ambulatory practice of an academic medical center
Introduction
Near patient point-of-care laboratory testing (POCT) offers reduced test turnaround time and can facilitate more efficient medical decision-making and clinical operations. In the primary care setting, many office visits result in the need for laboratory testing to complete the assessment of the patient. Three approaches to this task are commonly employed. During the visit the physician determines what laboratory tests are required and the patient is then sent to a central facility or a phlebotomy lab to obtain blood for testing. This approach imposes an extra laboratory visit on the patient and the test results are not available at the time of the visit, prompting follow-up phone calls, letters and, in some cases, a second visit. Prior to the visit the physician anticipates what tests will be required and instructs the patient to have blood drawn in advance of the appointment. In this scenario the test results are available at the time of the visit but the patient faces inconvenience by having to make a separate visit to the laboratory. This approach does not offer the opportunity to order unanticipated tests, which would require additional phlebotomy or lab visit after the appointment. POCT is performed in the clinical practice at the time of the office visit. This approach permits the tests to be determined and performed at the time of the visit and the results immediately reviewed with the patient.
A number of studies have reported improved outcomes following the implementation of POCT in a variety of inpatient and outpatient settings [1]. Outcomes can be classified into 3 general groups: medical outcomes (e.g. improved survival or control of disease), operational outcomes (e.g., improved patient throughput or decreased length-of-stay) or financial outcomes (e.g., reduced cost or improved cost effectiveness). The majority of published POCT trials assessing outcomes have focused on the efficiency of clinical operations including reductions in length of stay or elimination of cues in complex clinical operations [2]. Less often POCT has been shown to improve medical outcomes resulting in more rapid diagnosis or better compliance with accepted clinical guidelines such as glycemic control or improved anticoagulation management [3].
Only a few published studies have reported on patient satisfaction resulting from POCT as compared to testing in a centralized laboratory facility [4]. Patient satisfaction can be perceived as a “soft” outcome since it is not immediately related to clinical outcomes or the efficiency of clinical operations. Nonetheless measurement of patient satisfaction has become an important quality metric in many health care organizations, and may directly impact adherence to recommended treatment [5], [6], [7]. In this article we report our experience examining patient satisfaction with POCT in a primary care practice in an academic medical center. The menu of POC tests performed included hemoglobin A1c (HgA1c), lipid panel and comprehensive metabolic panel.
Section snippets
Methods
After institutional review board (IRB) approval, we performed the study in the Ambulatory Practice of the Future (APF) at the Massachusetts General Hospital (MGH) in Boston, MA. The APF is an adult primary care practice providing care to employees of the MGH and their spouses/domestic partners. The practice was launched in 2010, in part, as an innovative collaborative research site to develop new models for providing team-based primary care. The APF is presently staffed with three part-time
Results
A total of 97 patients (65%) returned the completed surveys to the anonymous collection site. Overall the mean satisfaction score on a scale of 1 (poor) to 4 (excellent) was 3.96. Only 2 of 97 patients gave a score less than 4 (one 3 and one 1) and without comment. One patient who received POCT could not stay for results reporting and discussion.
Overall, 60 HbA1c tests, 54 lipid panels and 59 comprehensive metabolic panels were tested. Many patients received more than one test (46.9%: one test,
Discussion
Patient satisfaction surveys are becoming increasingly used by both hospitals and individual clinics as an important measure of the standard and quality of care. Even consumers (patients) themselves now look to these tools to help distinguish important aspects of care and service among their choice of hospitals and clinics. Examples include the Consumer Assessment of Healthcare Providers and Systems (CAHPS: http://cahps.ahrq.gov/) and Press Ganey (www.pressganey.com). While meaningful in its
Acknowledgment
This study was funded or supported in part by Siemens Point-of-Care and Abaxis.
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Recipient of the Dr. Richard Winickoff Primary Care Fellowship at Massachusetts General Hospital.