Exclusion spirometry: a bad idea.

OBJECTIVE: To determine the incidence of errors anonymously reported by general practitioners in NSW. DESIGN: The Threats to Australian Patient Safety (TAPS) study used anonymous reporting of errors by GPs via a secure web-based questionnaire for 12 months from October 2003. SETTING: General practices in NSW from three groupings: major urban centres (RRMA 1), large regional areas (RRMA 2-3), and rural and remote areas (RRMA 4-7). PARTICIPANTS: 84 GPs from a stratified random sample of the population of 4666 NSW GPs - 41 (49%) from RRMA 1, 22 (26%) from RRMA 2-3, and 21 (25%) from RRMA 4-7. Participants were representative of the GP source population of 4666 doctors in NSW (Medicare items billed, participant age and sex). MAIN OUTCOME MEASURES: Total number of error reports and incidence of reported errors per Medicare patient encounter item and per patient seen per year. RESULTS: 84 GPs submitted 418 error reports, claimed 490 864 Medicare patient encounter items, and saw 166 569 individual patients over 12 months. The incidence of reported error per Medicare patient encounter item per year was 0.078% (95% CI, 0.076%-0.080%). The incidence of reported errors per patient seen per year was 0.240% (95% CI, 0.235%-0.245%). No significant difference was seen in error reporting frequency between RRMA groupings. CONCLUSIONS: This is the first study describing the incidence of GP-reported errors in a representative sample. When an anonymous reporting system is provided, about one error is reported for every 1000 Medicare items related to patient encounters billed, and about two errors are reported for every 1000 individual patients seen by a GP.

Family Practice↗

PubMed2006

Use of an open access spirometry service by general practitioners.

AIMS: To understand better which patients with which diagnoses or suspected diagnoses are referred for spirometry in primary care, and to assess whether all such referrals are appropriate. METHODS: 200 consecutive patient referrals to an open access spirometry service from ten local general practices were evaluated by perusing the request forms, and analysis of the spirometry results and the report sent to the general practitioner (GP). RESULTS: 51% of all referrals had suspected or stated COPD, but airway obstruction was demonstrated in only 53% of cases. A minority had a degree of reversibility which suggested an additional asthma component at least. Airway obstruction was rarely demonstrated in patients referred with stated or suspected asthma. 117 patients were referred with stated or suspected airway disease but had no evidence of airway narrowing on testing. 14.5% of these had an unexpected small lung (restrictive) disorder. Six of these had a BMI of more than 30. CONCLUSION: Most referrals with stated or suspected COPD were highly appropriate since spirometry is required in order to establish the correct diagnosis. Referral of patients with suspected asthma is less likely to be helpful, and a period of home peak flow monitoring may be more useful. Restrictive disorders can be confused with airway disorders, and obesity may be underestimated as a cause of breathlessness.

Family Practice↗