Issues and initiatives in the testing process in primary care physician offices

A 35-year-old woman with diabetes mellitus who had been treated for cystitis three days before calls your primary care office complaining of fever and flank pain. You call the lab to obtain the results of the culture and sensitivity you ordered, but only a urinalysis was performed. A chest x-ray is ordered for a 55-year-old smoker with a daily cough for one month. Three months later he arrives at the emergency department (ED) with hemoptysis, and the ED physician finds the x-ray result that shows a lung mass. It had been filed in the wrong chart and not reviewed. A patient with diabetes and hypertension who is on digoxin has an elevated creatinine. The physician reviewing the lab report containing this result misses it in the large number of results for this patient with multiple conditions and thus fails to address the worsening renal function.