The frequency of missed test results and associated treatment delays in a highly computerized health system

Wahls, Terry L.; Cram, Peter

doi:10.1186/1471-2296-8-32

Cited by 94 publications

(66 citation statements)

References 29 publications

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“…6 In the Gopalan study, the researchers incorrectly assumed that, due to ADA guidelines, HbA1C would be tested at least once within a 6 month period. 7,8,9 One study has shown a high missing data rate but high accuracy for HbA1C data; 10 and a diabetes RCT has recognized and planned accordingly for missing HbA1C data. 11…”

Section: Study Design Recommendationsmentioning

confidence: 99%

Prospective EHR-Based Clinical Trials: The Challenge of Missing Data

2014

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Section: Study Design Recommendationsmentioning

confidence: 99%

Prospective EHR-Based Clinical Trials: The Challenge of Missing Data

2014

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“…4 Comprehensive electronic result management systems have been successfully implemented in ambulatory settings; 16,17 however, gaps in test result management remain. 18 Initial attempts to improve inpatient test result management have not shown significant impact. 12,19 These results have illustrated that the workflow of hospital-based clinicians and the requirement to ensure follow-up of results after discharge from the hospital may necessitate different result management solutions for inpatient providers than those implemented in the ambulatory setting.…”

Section: Introductionmentioning

confidence: 99%

Impact of Automated Alerts on Follow-Up of Post-Discharge Microbiology Results: A Cluster Randomized Controlled Trial

et al. 2012

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BACKGROUND: Failure to follow up microbiology results pending at the time of hospital discharge can delay diagnosis and treatment of important infections, harm patients, and increase the risk of litigation. Current systems to track pending tests are often inadequate. OBJECTIVE: To design, implement, and evaluate an automated system to improve follow-up of microbiology results that return after hospitalized patients are discharged. DESIGN: Cluster randomized controlled trial. SUBJECTS: Inpatient and outpatient physicians caring for adult patients hospitalized at a large academic hospital from February 2009 to June 2010 with positive and untreated or undertreated blood, urine, sputum, or cerebral spinal fluid cultures returning post-discharge. INTERVENTION: An automated e-mail-based system alerting inpatient and outpatient physicians to positive post-discharge culture results not adequately treated with an antibiotic at the time of discharge. MAIN MEASURES: Our primary outcome was documented follow-up of results within 3 days. Secondary outcomes included physician awareness and assessment of result urgency, impact on clinical assessments and plans, and preferred alerting scenarios. KEY RESULTS: We evaluated the follow-up of 157 postdischarge microbiology results from patients of 121 physicians. We found documented follow-up in 27/97 (28%) results in the intervention group and 8/60 (13%) in the control group [aOR 3.2, (95% CI 1.3-8.4); p=0.01]. Of all inpatient physician respondents, 32/82 (39%) were previously aware of the results, 45/77 (58%) felt the results changed their assessments and plans, 43/77 (56%) felt the results required urgent action, and 67/70 (96%) preferred alerts for current or broader scenarios.CONCLUSION: Our alerting system improved the proportion of important post-discharge microbiology results with documented follow-up, though the proportion remained low. The alerts were well received and may be expanded in the future.KEY WORDS: reminder systems; pending test results; transitions of care; test result management; delays in diagnosis.

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“…Some authors have introduced the "pre-pre-" and "post-post-" analytical phases to identify activities associated with the initial selection of tests and with the interpretation by clinicians respectively, to differentiate them for the pure collection/transport activities (pre-analytical phase) and reporting (postanalytical phase) 13, 14 . There is some evidence that these steps are more error-prone than other pre-and postanalytical activities [13][14][15][16][17][18] .However, the definition and use of such terms is not universal. Indeed the definition of even basic terms such as pre-analytical, analytical and post-analytical can vary between authorities.…”

Section: Introductionmentioning

confidence: 99%

Errors in laboratory medicine: The role of quality indicators

Mohanty¹

2020

IJCBR

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Errors in laboratory are heterogeneous in nature as it involves various complex procedures and a variety of persons preforming all the processes, starting from ordering of tests to reporting of result to its influence on ultimate patient care. The core job of a laboratory is to produce the correct test result. If we can't get the test results right, then we aren't doing our core job. It's our profession to know all the details of testing and instrumentation and quality control. It's our profession to assure that test results are correct. Improvements need not be only at "pre" or "post" or "analytical" -it should be at all three stages, as the consequence of error in any of the stage is the same: poor patient care. No error is worse than the other. We must make efforts on all fronts. Even if this means making small improvements in each area, a unified improvement effort will achieve better test results and better patient care than narrow efforts in either the pre-, post-or analytical area. To have a uniform consensus, the laboratories should have certain quality indicators to have control over the procedures that tend to generate errors.

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The frequency of missed test results and associated treatment delays in a highly computerized health system

Cited by 94 publications

References 29 publications

Prospective EHR-Based Clinical Trials: The Challenge of Missing Data

Prospective EHR-Based Clinical Trials: The Challenge of Missing Data

Impact of Automated Alerts on Follow-Up of Post-Discharge Microbiology Results: A Cluster Randomized Controlled Trial

Errors in laboratory medicine: The role of quality indicators

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