Interventions to Improve Follow‐Up of Laboratory Test Results Pending at Discharge: A Systematic Review

Abstract

Failure to follow up test results pending at discharge (TPAD) from hospitals or emergency departments is a major patient safety concern. The purpose of this review is to systematically evaluate the effectiveness of interventions to improve follow-up of laboratory TPAD. We conducted literature searches in PubMed, CINAHL, Cochrane, and EMBASE using search terms for relevant health care settings, transition of patient care, laboratory tests, communication, and pending or missed tests. We solicited unpublished studies from the clinical laboratory community and excluded articles that did not address transitions between settings, did not include an intervention, or were not related to laboratory TPAD. We also excluded letters, editorials, commentaries, abstracts, case reports, and case series. Of the 9,592 abstracts retrieved, 8 met the inclusion criteria and reported the successful communication of TPAD. A team member abstracted predetermined data elements from each study, and a senior scientist reviewed the abstraction. Two experienced reviewers independently appraised the quality of each study using published LMBP™ A-6 scoring criteria. We assessed the body of evidence using the A-6 methodology, and the evidence suggested that electronic tools or one-on-one education increased documentation of pending tests in discharge summaries. We also found that automated notifications improved awareness of TPAD. The interventions were supported by suggestive evidence; this type of evidence is below the level of evidence required for LMBP™ recommendations. We encourage additional research into the impact of these interventions on key processes and health outcomes.

The impact of health information technology on the management and follow-up of test results – a systematic review

“…This interconnectedness is conceptualized in Figure 3, which is constructed from the key outcome measures identified within the existing research, as a basis for examining the significance and implications of the research. These layers can be described as: 1) the organizational-communication environment (eg, existing practices about how test results are communicated), 55 , 60 2) the diagnostic process (eg, the numerous tasks among different people and across different clinical settings that need to be coordinated and synchronised for safe and effective test results management), 20 , 86 and 3) patient engagement in the test results follow-up process (eg, how and when do patients access test results, if at all?) 68 , 74 , 75 …”

“…This is particularly relevant to test results management, where the way that information is collected, reported, and presented can have major safety consequences 18 , 19 . Despite a growing evidence base of the diffusion of health IT applications, 6 their impact on test results follow-up, management, and patient engagement has not been widely appraised and is not well understood 20 , 21 . This systematic review integrates quantitative and qualitative research findings on how health IT has been used to engage with patients.…”

Ambulatory Safety Nets to Reduce Missed and Delayed Diagnoses of Cancer

“…In general, interventions addressing ambulatory safety related to missed and delayed diagnoses have been understudied in contrast to the inpatient setting. 4 , 11 , 12 Recognizing this need The Joint Commission Perspectives recently called for comments on processes for timely reporting and follow-up on all test results and for all patients. 13 Safety nets like the ones described in this study can provide an innovative approach by incorporating multiple, cross-cutting factors (including interdisciplinary teams), facilitating infrastructure development such as reporting tools and registries, and promoting a culture of safety.…”

Variation in electronic test results management and its implications for patient safety: A multisite investigation

“…A wide variety of HIT-enabled interventions 9 have been designed to assist clinicians in managing test results, including computerized physician order entry, 10 electronic results acknowledgment, 11–14 automated email notifications of TPADs, 2 , 3 and electronic health record (EHR) alerts. 15 , 16 Evaluations of HIT interventions have reported improvements in awareness, communication, and access to clinical test results, 4 , 11 , 14 as well as in efficiency, response time, and the proportions of tests being followed up. 5 , 16 Notwithstanding the benefits of HIT, delayed 17 or missed test results 10 , 18 and failure to follow-up test results 19–21 persist and pose a serious safety issue in healthcare.…”