Linking acknowledgement to action: closing the loop on non-urgent, clinically significant test results in the electronic health record

Abstract

Failure to follow-up nonurgent, clinically significant test results (CSTRs) is an ambulatory patient safety concern. Tools within electronic health records (EHRs) may facilitate test result acknowledgment, but their utility with regard to nonurgent CSTRs is unclear. We measured use of an acknowledgment tool by 146 primary care physicians (PCPs) at 13 network-affiliated practices that use the same EHR. We then surveyed PCPs to assess use of, satisfaction with, and desired enhancements to the acknowledgment tool. The rate of acknowledgment of non-urgent CSTRs by PCPs was 78%. Of 73 survey respondents, 72 reported taking one or more actions after reviewing a CSTR; fewer (40-75%) reported that using the acknowledgment tool was helpful for a specific purpose. Forty-six (64%) were satisfied with the tool. Both satisfied and nonsatisfied PCPs reported that enhancements linking acknowledgment to routine actions would be useful. EHR vendors should consider enhancements to acknowledgment functionality to ensure follow-up of nonurgent CSTRs.

The Impact of Automated Notification on Follow-up of Actionable Tests Pending at Discharge: a Cluster-Randomized Controlled Trial

“…Most major EHR vendors can extend existing functionality to externally notify clinicians of actionable TPADs via institutional email, secure messaging, or mobile app Bpush^notifications; flag importance in subject headings or notification banners; In sub-group analyses for documented acknowledgment, percentages, ORs, and p values calculated were similar across all characteristics and was statistically significant for Elixhauser (I vs. C: 64.0 vs. 50.0%; adjusted OR 1.84 [0.80, 4.2]; p = 0.04) facilitate knowledge transfer via messaging threads between key inpatient and ambulatory clinicians; and request acknowledgment electronically. 7,16,17,39,40 Institutions considering this type of Bactive^strategy would benefit from notifying nonnetwork as well as network PCPs-technology to send out-ofnetwork messages securely is increasingly available with growth of online physician directories and professional networks. 41 Leveraging EHRs, communication tools, and online resources in this way can address safety concerns related to discontinuity within and across healthcare systems.…”

“…J Gen Intern Med 33 (7):1043-51 DOI: 10.1007/s11606-018-4393-y © Society of General Internal Medicine 2018 BACKGROUND More than half of preventable adverse events after discharge are related to poor communication. 1,2 In prior work, we determined that 41% of patients left the hospital before all test results were finalized.…”

“…4 Depending on the result, follow-up may include establishing a diagnosis, altering therapy, arranging an ambulatory appointment, initiating referral to a consultant, ordering additional tests, or communicating with patients. [5][6][7] Although documented follow-up has been evaluated for certain actionable TPADs (e.g., microbiology), 5,8 there are few data for other test types, services, clinicians, and EHRs. This research is difficult because clinicians may have different perspectives about whether specific TPADs are actionable depending on context, specialty, and role on the care team.…”

Results of Laboratory Tests not Accessed in Brazilian Private Laboratories

“…According to Rodrigues-Borja and collaborators [10], the delay in reviewing test results by doctors influences the quality of the healthcare assistance. There is already consistent evidence showing that the test management process represents a significant source of error and harm to the patients [11][12][13].…”

“…Nevertheless, according to Singh and collaborators (2007) [22], the follow-up and communication of test results, including the critical ones, do not reach 100%, even in those organizations with sophisticated and mature electronic health records. Among the possible technology information contributions to solve access problems to laboratory test results are warnings about pending test results and released results, in addition to tracking systems on clinical actions and decisions, based on the test results received [12,16]. Despite the fact that the data obtained in this work were extracted through a different methodology from the one used in other studies, the results confirm the need to awaken an awareness about those potential risks, both within the medical environment and the patients themselves, warning about possible adverse events and the costs they represent to the healthcare systems.…”