Preventing Diagnostic Errors in Ambulatory Care: An Electronic Notification Tool for Incomplete Radiology Tests

Abstract

Background Failure to complete recommended diagnostic tests may increase the risk of diagnostic errors. Objectives The aim of this study is to develop and evaluate an electronic monitoring tool that notifies the responsible clinician of incomplete imaging tests for their ambulatory patients. Methods A results notification workflow engine was created at an academic medical center. It identified future appointments for imaging studies and notified the ordering physician of incomplete tests by secure email. To assess the impact of the intervention, the project team surveyed participating physicians and measured test completion rates within 90 days of the scheduled appointment. Analyses compared test completion rates among patients of intervention and usual care clinicians at baseline and follow-up. A multivariate logistic regression model was used to control for secular trends and differences between cohorts. Results A total of 725 patients of 16 intervention physicians had 1,016 delayed imaging studies; 2,023 patients of 42 usual care clinicians had 2,697 delayed studies. In the first month, physicians indicated in 23/30 cases that they were unaware of the missed test prior to notification. The 90-day test completion rate was lower in the usual care than intervention group in the 6-month baseline period (18.8 vs. 22.1%, p = 0.119). During the 12-month follow-up period, there was a significant improvement favoring the intervention group (20.9 vs. 25.5%, p = 0.027). The change was driven by improved completion rates among patients referred for mammography (21.0 vs. 30.1%, p = 0.003). Multivariate analyses showed no significant impact of the intervention. Conclusion There was a temporal association between email alerts to physicians about missed imaging tests and improved test completion at 90 days, although baseline differences in intervention and usual care groups limited the ability to draw definitive conclusions. Research is needed to understand the potential benefits and limitations of missed test notifications to reduce the risk of delayed diagnoses, particularly in vulnerable patient populations.

Improving ACGME Compliance for Obstetric Anesthesiology Fellows Using an Automated Email Notification System

“…They found higher rates of completion in the intervention group, although some baseline differences in patient characteristics may account for their findings. 5 There are also numerous ways in which an informatics solution similar to the one proposed here can be applied to improve processes in graduate medical education. First, the process of identifying educationally high-yield cases or achieving case minimum requirements for trainees can be similarly applied in other specialties.…”

“…Prior work suggests that communication challenges within the health care system can be successfully overcome through the use of informaticsbased solutions. [4][5][6] Objectives Thus, we designed and implemented a quality improvement project which created an informatics-based electronic notification system, with the aim of increasing fellow participation in nonobstetric antenatal surgeries performed during pregnancy.…”

A Web Application for Adrenal Incidentaloma Identification, Tracking, and Management Using Machine Learning

“…Improved methods for tracking and managing these findings as well as the associated follow-up recommendations are required. Previous work has demonstrated that electronic notification tools can be useful in improving adherence to follow-up imaging test completion, 10,11 highlighting the importance of exploring alternative methods of notifying providers of the need for follow-up. In particular, a centralized system which maintains a database of outstanding incidental findings and allows for multiuser management over time would solve many of these issues, as it would not rely on variable individual workflows.…”

Feasibility and Reliability Testing of Manual Electronic Health Record Reviews as a Tool for Timely Identification of Diagnostic Error in Patients at Risk

“…[6][7][8] The multiple factors that cause DEs range from cognitive failures on the part of individuals, including diagnosing clinicians, system failures for tracking and managing test results, and poor teamwork and communication. [9][10][11][12] Despite the importance of DE, the process of reporting errors and near misses remains underdeveloped and lacks standardized measurement tools. 13,14 DEs more often result in death and are the leading cause of claims-associated death and disability; indeed, until a decade ago, much of what was known about DE was learned through the evaluation of data from malpractice claims.…”