The Rate of Missed Test Results in an Emergency Department

J. Callen; R. Paoloni; A. Georgiou; M. Prgomet; J. Westbrook

doi:10.3414/ME09-01-0011

Methods of Information in Medicine, Inhaltsverzeichnis

Methods Inf Med 2010; 49(01): 37-43
DOI: 10.3414/ME09-01-0011

Original Articles

Schattauer GmbH

The Rate of Missed Test Results in an Emergency Department

An Evaluation Using an Electronic Test Order and Results Viewing System

Authors

J. Callen

¹Health Informatics Research and Evaluation Unit, The University of Sydney, Sydney, Australia
R. Paoloni

²Concord Repatriation General Hospital, Sydney, Australia
A. Georgiou

¹Health Informatics Research and Evaluation Unit, The University of Sydney, Sydney, Australia
M. Prgomet

¹Health Informatics Research and Evaluation Unit, The University of Sydney, Sydney, Australia
J. Westbrook

¹Health Informatics Research and Evaluation Unit, The University of Sydney, Sydney, Australia

Abstract

Summary

Objectives: 1) To measure the incidence and impact of missed radiology and microbiology test results in an emergency department with an electronic test order and results viewing system, and 2) to assess the average times from test order to test availability.

Methods: The study was conducted in the emergency department (ED) of a 370-bed metropolitan teaching hospital in Sydney, Australia. A computerised provider order entry (CPOE) system was used to order all diagnostic tests and view all test results. For microbiology and radiology tests electronic results were then printed for ED patients not admitted to the hospital to allow ED physicians to document follow-up. All radiology (n = 197) and microbiology (n = 66) tests ordered and results received for discharged ED patients were collected for a seven-day period. We measured the: 1) proportion of radiology and microbiology test results without follow-up for discharged patients; 2) impact of non follow-up on patient outcomes; 3) average time from radiological examination and microbiology specimen collection to reporting of results; and 4) average time from reporting of results to follow-up.

Results: Two radiology (1.0%) and two microbiology reports (3.0%), all of which had negative findings, were never followed-up. Review of these patients’ medical records indicated there was no impact on patient outcomes or management. The average time from radiological examination to reporting of a result was 1.5 days, and from microbiology specimen collection to reporting was 2.5 days. Eighty-nine percent of radiology and 68% of microbiology results were followed-up on the same day that they were available to physicians.

Conclusions: Our rates of missed test results are lower than those reported from studies where paper ordering and reporting systems were used. This suggests that the availability of CPOE systems may reduce the risk of these events. Electronic result delivery, with electronic endorsement to allow documentation of follow-up of test results, may provide additional efficiency benefits and further reduce the risk of test results which are not followed up.

Keywords

Information systems - CPOE - diagnostic tests - health care quality improvement - patient safety

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Referenzen

References
1 Institute of Medicine.. Crossing the quality chasm: a new health system for the 21st Century. Washington DC: National Academy Press; 2001
2 Kohn LT, Corrigan JM, Donaldson MS. (eds). To err is human: building a safer health system. Washington DC: National Academy Press; 2000
3 Murff HJ, Gandhi TK, Karson AK. et al. Primary care physician attitudes concerning follow-up of abnormal test results and ambulatory decision support systems. Intern J Med Inform 2003; 71: 137-149.
4 Roy CL, Poon EG, Karson AS. et al. Patient safety concerns arising from test results that return after hospital discharge. Ann Intern Med 2005; 143: 121-128.
5 Cram P, Rosenthal GE, Ohsfeldt R. et al. Failure to recognize and act on abnormal test results: a case of screening bone densitometry. Jt Comm J Qual Patient Saf 2005; 31: 90-97.
6 Gandhi TK. Fumbled handoffs: one dropped ball after another. Ann Intern Med 2005; 142: 352-358.
7 Kuperman GJ, Teich JM, Tanasijevic MJ. et al. Improving response to critical laboratory results with automation: results of a randomized controlled trial. J Am Med Inform Assoc 1999; 6: 512-522.
8 Poon EG, Gandhi TK, Sequist TD. et al. I wish I had seen this test result earlier! Dissatisfaction with test result management systems in primary care. Arch Intern Med 2004; 164: 2223-2228.
9 Singh H, Sethi S, Raber M. et al. Errors in cancer diagnosis: current understanding and future directions. J Clin Oncol 2007; 25: 5009-5018.
10 Bird S. Missing test results and failure to diagnose. Aust Fam Physician 2004; 33: 360-361.
11 Boohaker EA, Ward RE, Uman JE. et al. Patient notification and follow-up of abnormal test results: a physician survey. Arch Intern Med 1996; 156: 327-331.
12 Karcz A, Holbrook J, Burke MC. et al. Massachusetts emergency medicine closed malpractice claims: 1988-1990. Ann Emerg Med 1993; 22: 553-559.
13 Osuch JR, Bonham VL, Morris LL. Primary care guide to managing a breast mass: a legal perspective on risk management. Medscape Womens Health 1998; 3: 3.
14 Meza JP, Webster DS. Patient preferences for laboratory test results notification. Am J Manag Care 2000; 6: 1297-1300.
15 Callen JL, Westbrook JI, Braithwaite J. The effect of physicians’ long-term use of CPOE on their test management work practices. J Am Med Inform Assoc 2006; 13: 643-652.
16 Haas JS, Cook EF, Puopolo AL. et al. Differences in the quality of care for women with an abnormal mammogram or breast complaint. J Gen Intern Med 2000; 15: 321-328.
17 Marcus AC, Crane LA, Kaplan CP. et al. Improving adherence to screening follow-up among women with abnormal pap smears: results from a large clinic-based trial of three intervention strategies. Med Care 1992; 30: 216-230.
18 Marcus AC, Kaplan CP, Crane LA. et al. Reducing loss to follow-up among women with abnormal pap smears: results from a randomized trial testing an intensive follow-up protocol and economic incentives. Med Care 1998; 36: 397-410.
19 Poon EG, Haas JS, Puopolo AL. et al. Communication factors in the follow up of abnormal mammograms. J Gen Intern Med 2004; 19: 316-323.
20 Moore C, Wisnivesky J, Willians S. et al. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med 2003; 18: 646-651.
21 Kilpatrick ES, Holding S. Use of computer terminals on wards to access emergency test results: a retrospective audit. BMJ 2001; 322: 1101-1103.
22 Leape LL. Error in medicine. JAMA 1994; 272: 1851-1857.
23 Stiell A, Forster AJ, Stiell IG. et al. Prevalence of information gaps in the emergency department and the effect on patient outcomes. Can Med Assoc J 2003; 169: 1023-1028.
24 Poon EG, Wang SJ, Gandhi TK. et al. Design and implementation of a comprehensive outpatient results manager. J Biomed Inform 2003; 36: 80-91.
25 Anderson GF, Frogner BK, Johns RA. et al. Health care spending and use of information technology in OECD countries. Health Aff 2006; 25: 819-831.
26 Cross M. Keeping the NHS electronic spine on track. BMJ 2006; 332: 656-658.
27 National Programme for Information Technology.. National programme for information technology – benefits timeline 2004. http://wwwnpfitnhsuk/ publications/sha_comms_tk/all_images_and_ docs/benfits_timelinepdf" (accessed March 2005).
28 Bates DW, Cohen M, Leape LL. et al. Reducing the frequency of errors in medicine using information technology. J Am Med Inform Assoc 2001; 8: 299-308.
29 Collin S, Reeves B, Hendy J. et al. Implementation of computerised physician order entry (CPOE) and picture archiving and communication systems (PACS) in the NHS: quantitative before and after study. BMJ 2008; 337: a939.
30 Westbrook J, Braithwaite J, Iedema R. et al. Multimethod evaluation of information and communication technologies in health in the context of wicked problems and socio-technical theory. J Am Med Inform Assoc 2007; 14: 746-755.
31 Hickner JM, Fernald DH, Harris DM. et al. Communicating critical test results: issues and initiatives in the testing process in primary care physician offices. Jt Comm J Qual Patient Saf 2005; 31: 81-89.
32 Singh H, Naik AD, Rao R. et al. Reducing diagnostic errors through effective communication: harnessing the power of information technology. J Gen Intern Med 2007; 23: 489-494.
33 Keren R, Muret-Wagstaff S, Goldmann DA. et al. Notifying emergency department patients of negative test results: pitfalls of passive communication. Pediatr Emerg Care 2003; 19: 226-230.
34 Greenes DS, Fleisher GR, Kohane I. Potential impact of a computerized system to report late-arriving laboratory results in the emergency department. Pediatr Emerg Care 2000; 16: 313-315.
35 Bates DW, Leape LL. Doing better with critical test results. Jt Comm J Qual Patient Saf 2005; 31: 66-67.
36 Saxena S, Kempf R, Wilcox S. et al. Critical laboratory value notification: a failure mode effects and criticality analysis. Jt Comm J Qual Patient Saf 2005; 31: 495-506.
37 Hanna D, Griswold P, Leape LL. et al. Communicating critical test results: safe practice recommendations. Jt Comm J Qual Patient Saf 2005; 31: 68-80.