Lab Order Errors: Where They Start and How to Prevent Them

A lab order error is any mistake in choosing, entering, or transmitting a test request. It includes the wrong test, a duplicate, a missing test, the wrong priority, or the wrong ordering physician. Most of these errors can be prevented, because most start in steps your own team controls: the requisition, the order entry, and the handoff to the laboratory. This guide explains how often they happen, what causes them, and how practices, urgent care centers, long-term care facilities, and research sites can reduce them with a repeatable process.

TL;DR

• In a large College of American Pathologists study, 4.8% of outpatient requisitions had at least one order-entry error, and some institutions were far above that.
• Most laboratory errors happen before the specimen is tested, in ordering and collection, often outside the lab itself.
• Common causes include verbal orders, no cross-check against the requisition, routine panels, and fragmented information systems.
• Prevention works best as a combination: electronic order entry, standard order sets, duplicate alerts, chart audits, and a lab partner who talks to you directly.
• A lab that integrates with your EHR and returns results electronically removes several manual steps where mistakes creep in.

What counts as a lab order error

The testing process has more steps than most teams picture. The Agency for Healthcare Research and Quality (AHRQ) classifies test selection, ordering, and specimen collection as preanalytic, performing the test as analytic, and interpretation, reporting, and use of results as postanalytic. An order error sits at the very start of that chain, so it travels through every later step.

In practice, order errors fall into a few groups:

• Wrong test: a similar-sounding test is selected instead of the intended one.
• Missing or extra test: a test is on the paper requisition but not in the computer record, or a test is performed that nobody requested.
• Duplicate test: the same test is ordered twice, or a recurring order keeps running after it is no longer needed.
• Administrative mismatch: the ordering physician, patient identifier, or priority does not match across documents.
• Inappropriate test: the test is correctly ordered but does not fit the clinical question.

The last group deserves attention. A 2017 U.S. laboratory-stewardship guideline states that 10% to 30% of laboratory tests are unnecessary or inappropriate, which makes appropriateness part of the same conversation as accuracy.

How often lab order errors happen

The most cited benchmark comes from the CAP Q-Probes study of outpatient order accuracy. Across 114,934 requisitions from 660 laboratories, 5,514 requisitions (4.8%) had at least one order-entry error. The median institution reported 6.0%, and 10% of institutions reported errors on at least 18% of requisitions. That study is from 1999, so treat it as a benchmark for how wide the spread between organizations can be, not as a current national rate. The spread is the useful lesson: the gap between the best and worst performers came largely from process, not from luck.

More recent data point the same direction. A 2024 Clinical Chemistry study covering about 40 million results from 11 million specimens recorded 87,317 errors, about 0.8% of specimens. After excluding minimal hemolysis, 97.0% of the remaining errors were preanalytical. A 2020 review places preanalytical errors at roughly 61.9% to 68.2% of total laboratory errors, and the American Society for Clinical Laboratory Science notes that preanalytical errors often originate outside the laboratory.

The 2017 stewardship guideline adds two numbers worth knowing for genetic testing: about 5% of genetic-test orders are frank medical errors, and about 7% of results are never retrieved or are significantly delayed (same guideline).

Common lab order errors, with examples

The table below pulls together the examples documented in the research.

The first three rows come from the 2017 stewardship guideline. The last two come from the CAP study, where physician-name discrepancies were the most frequent of four order-entry error categories. Notice how mundane these are. None of them reflects a clinical failing. They reflect a process that depends on people copying information by hand.

What causes lab order errors

The CAP study linked higher order-entry error rates to verbal orders, no policy requiring cross-checks against requisitions, and failure to monitor accuracy regularly. Those are all process gaps you can close.

Other causes show up in the literature:

• Routine panels and retesting habits. A 2020 review reports that routine ordering panels and non-adherence to retesting intervals drive overutilization.
• Poor communication across locations. Laboratory technical professionals interviewed in a 2022 study said that poor communication among generalists, specialists, locations, and departments can cause duplicate testing, and fragmented information systems make prior results hard to find.
• Uncertainty at the point of ordering. A 2024 diagnostic-stewardship toolkit reports that almost 15% of surveyed primary-care physicians were unsure which test to order and about 8% were unsure how to interpret results.

That last point is a reminder that a good lab relationship is partly about access to people. When a clinician can call the lab and ask which test fits the question, an error is avoided before it exists.

Why lab order errors matter for patients

Most order errors are caught and cause no harm. In a three-year incident-report study from Thailand, 98% of reported events caused no patient harm, and incorrect test ordering accounted for 48.2% of the errors. That result reflects one country’s reporting system, but it shows two things: the ordering step is a leading source of events, and good detection keeps most of them from reaching patients.

When errors do get through, the consequences run in two directions. The diagnostic-stewardship toolkit says incorrect ordering, inaccurate or incomplete results, and misinterpretation can lead to false-positive diagnoses and overtreatment, or to delayed and missed diagnoses and undertreatment. AHRQ gives a concrete example: a urine culture in a patient without urinary symptoms can lead to a false urinary tract infection diagnosis and unnecessary antibiotics.

Underuse matters as much as overuse. One review found that closed malpractice claims identified test underuse as a contributor in up to 55% of ambulatory cases, though it cautioned that the evidence base is limited. The goal is the right test, for the right patient, at the right time, not simply fewer tests.

Where order errors fit in the testing process

Because order errors are preanalytical, they are easy to blame on the lab and hard to see from the lab. The specimen arrives labeled, the test runs correctly, and the result is accurate, yet the answer addresses the wrong question.

That is why a total-process view helps. AHRQ’s testing model runs from ordering and performing the test through tracking results, returning them to the office, clinician review, documentation, patient notification, and follow-up, and a failure at any step can create an error or safety risk. Laboratory quality guidance similarly says risk assessment should cover the full process from specimen collection through analysis and final reporting.

If you want to see how the specimen side of this plays out for research and clinical teams, our article on preanalytical variables and AI quality assurance goes deeper into collection, labeling, and handling.

The postanalytical end of the chain

Order accuracy also shows up at the other end. A correct order can still produce a problem if the result is not retrieved, not reviewed, or misread. This is especially true for marker-based monitoring, where a series of results over time has to be interpreted against a plan. A structured bone turnover marker monitoring plan is one example of how clinicians define which markers to order, when, and how to read them, so the result lands in the chart with a clear next step.

How to prevent lab order errors: a practical sequence

No single fix works. Laboratory medicine experts recommend combining education and feedback with decision support, interpretive comments, duplicate and interval alerts, reflex pathways, gatekeeping for selected tests, and diagnostic-management teams rather than relying on one intervention. Here is a sequence that turns that advice into work a practice manager can assign.

1. Map your testing process. Write down every step from order to patient follow-up, and note who owns each one. AHRQ’s toolkit recommends mapping the process and using chart audits to review orders, results, documentation, notification, follow-up, and task timing.
2. Audit a small sample. The same toolkit suggests at least 10 audits before and after a change, and 20 for a more reliable measurement. Start small and repeat.
3. Move orders into electronic entry. Recommended controls include computerized provider order entry, standardized order sets and algorithms, hiding commonly misordered tests, duplicate-order alerts, and time-sensitive stop orders for recurring daily tests.
4. Retire verbal orders where you can. Where you cannot, require a written or electronic confirmation and a cross-check against the requisition.
5. Standardize order sets by visit type. Urgent care, annual physicals, and chronic disease follow-ups each deserve a vetted set, reviewed at a set interval.
6. Set retesting intervals. Build the interval into the order so that a repeat request prompts a question.
7. Close the loop on results. Track every order to a result, a clinician review, and a patient notification.
8. Review the numbers regularly. The CAP study tied higher error rates to failing to monitor accuracy, so make a short monthly review part of your routine.

Protect necessary testing

Safety controls should trim inappropriate orders without suppressing the necessary ones. A 2024 review of intensive care interventions found that evaluated reductions in inappropriate testing did not worsen patient-safety outcomes, while noting limits in study quality. Design alerts to prompt a second look, not to block care.

Settings with their own order-error risks

The same principles apply everywhere, but the failure points differ.

• Urgent care and primary care: high volume and rotating clinicians make standardized order sets the biggest lever.
• Specialty practices: repeat monitoring orders need clear intervals and ownership. Our piece on lab testing optimization for single-specialty practices covers this.
• Skilled nursing and long-term care: standing orders and multiple prescribers raise the risk of recurring tests that outlive their purpose.
• Home health: orders are placed in one location and specimens collected in another, so identifiers and requisitions have to travel together.
• Clinical research sites: protocol-specific panels and visit schedules require exact matching between the order, the kit, and the sample. See our overview of clinical trial laboratory services.
• Safety monitoring: scheduled monitoring labs are easy to miss. Our article on four windows that fix safety lab monitoring shows how to structure them.

How a lab partner helps reduce order errors

Laboratory staff are an underused part of error prevention. The 2017 stewardship guideline says lab staff can guide clinicians to test information and algorithms, facilitate pathologist consultations, and collaborate with clinicians to support retrieval of results and clear reports.

When you choose a laboratory, ask practical questions tied to the steps above:

• Can the lab integrate with your EHR so orders flow in electronically rather than on paper?
• Does it return results electronically and into a portal your team can use?
• Who do you call when you are unsure which test fits?
• Does the lab handle specimen pickup, so labeling and transport are consistent?
• Does the lab onboard and train your staff on ordering?

Those are the services we built KoHealth Labs around. For a closer look at how connected workflows affect daily operations, read how integrated diagnostics improve clinic efficiency.

Our perspective

We see order errors as a design problem before we see them as a people problem. When a clinician has to retype an order, guess between two similar test names, or wait on hold to ask a question, mistakes become likely.

That is why we focus on the pieces around the test itself: Laboratory Information System and EHR integration, electronic results reporting, specimen pickup, mobile phlebotomy, and onboarding and training for your team. Each one removes a manual handoff.

We also believe in direct communication. Our approach is built on responsive, personalized service, so your physicians and office managers can reach people who know your account and can help you choose the right test the first time.

For practices, we can act as your primary laboratory or as an added resource for specialized testing. For research organizations, we offer a collaborative partnership focused on study protocols and specimen logistics.

Kohealth Labs

Work with a lab built around your workflow

If you manage a practice, a long-term care facility, a home health agency, or a clinical study, we can walk you through how our services fit your ordering process. We offer clinical laboratory and molecular testing, specimen pickup, mobile phlebotomy, electronic results reporting, and LIS and EHR integration, with onboarding and training for your staff.

See how faster diagnostics work with your team, or start at KoHealth Labs to talk with us about becoming your primary or supplemental laboratory.

FAQ

How often do labs make errors?

It depends on how you count. A 2024 study of about 11 million specimens recorded errors in roughly 0.8% of specimens, and most were preanalytical. An older CAP study found order-entry errors on 4.8% of outpatient requisitions. Rates vary widely between organizations, which is why local audits matter.

What causes lab errors?

Most start before the test is run: ordering, requisition handling, specimen collection, labeling, and transport. Research links order errors to verbal orders, missing cross-checks, routine panels, poor communication between locations, and fragmented information systems.

What are the most common lab order errors?

Examples include selecting a look-alike test, such as the wrong form of vitamin D or folate, duplicate or recurring daily orders, tests on the requisition but missing from the electronic record, and physician-name or priority mismatches.

How can a practice catch order errors early?

Map your testing process and audit a small sample of charts, at least 10 before and after any change and ideally 20. Compare each order with the requisition, the result, and the follow-up documentation. Repeat on a regular schedule so problems surface early.

Sources

• AHRQ: Diagnostic Error in the Testing Process
• AHRQ: Improving Your Laboratory Testing Process Toolkit
• CAP Q-Probes: Outpatient order accuracy
• Transforming Laboratory Utilization Review into Laboratory Stewardship (2017)
• Errors within the total laboratory testing process (2020)
• Causes of Inappropriate Laboratory Test Ordering (2022)
• Diagnostic Stewardship Toolkit
• Diagnostic errors in clinical laboratory testing process
• Preanalytical Phase Errors, Clinical Chemistry (2024)
• ASCLS: The Preanalytical Errors
• Laboratory Quality Control Based on Risk Management
• Interventions to improve appropriateness of laboratory testing in the ICU
• Bone turnover marker monitoring plan

For more information about our diagnostic testing, clinical research laboratory services, or partnership opportunities, visit https://kohealthlabs.com or contact KoHealth Labs at (469) 792-8439 and ask for Amy Patterson.