Timely Follow-up of Abnormal Diagnostic Imaging Test Results in an Outpatient Setting

Singh, Hardeep; Thomas, Eric J.; Mani, Shrinidi; Sittig, Dean F.; Arora, Harvinder; Espadas, Donna; Khan, Myrna M.; Petersen, Laura A.

doi:10.1001/archinternmed.2009.263

Cited by 187 publications

(185 citation statements)

References 37 publications

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“…Improved visibility helps radiologists demonstrate the value they already currently provide [1,7]. Additional "value" through direct communication could result from a reduced number of intermediary communication errors, decreased delays in patient management, reduced patient stress and anxiety, and improved patient adherence to follow-up recommendations [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Patients Prefer Results From the Ordering Provider and Access to Their Radiology Reports

Cabarrus

Naeger

Rybkin

et al. 2015

Journal of the American College of Radiology

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Purpose: Imaging results are generally communicated to patients by referring providers. Directly communicating results has been suggested as a way for radiologists to add value, though few studies have investigated patients' preferences in this regard. The aim of this study was to determine patients' preferences for receiving their imaging results. Methods:In this institutional review board-approved study, adult outpatients undergoing CT or MRI at an academic medical center and an affiliated county hospital over a 4-week period (n ¼ 2,483) were surveyed. The survey assessed patients' preferred delivery method for radiology results and their understanding of radiologists' education and role.Results: A total of 617 surveys (25% response rate) were completed, 475 (77%) and 142 (23%) by academic medical center and county hospital patients, respectively. Among all respondents, the majority of patients (387 of 617 [63%]) preferred models of results delivery centered on the referring physician as opposed to the radiologist. Regardless of who verbally relayed the results, 64% of all respondents (398 of 617) wanted the option to receive a copy of the report, and 522 of 614 (85%) wanted to see their images. Among patients wanting copies of their reports, academic medical center patients expressed equal interest in mail, e-mail, and online portal options (33%, 31%, and 36%, respectively), and county hospital patients preferred mail (55%, 28%, and 17%, respectively) (P < .001).Conclusions: Patients prefer receiving their imaging results through their referring providers. Many patients would also like to view their images and receive copies of their reports, potential avenues through which radiologists could add value.

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Section: Introductionmentioning

confidence: 99%

“…First among these unknowns are the preferences of patients. Few studies have examined patients' preferences, and those that have, have yielded conflicting results [8][9][10][11][12][13]. Additionally, most previously published studies involved surveys of outpatients at single institutions, resulting in narrowly selected groups of patients.…”

Section: Introductionmentioning

confidence: 99%

Patients Prefer Results From the Ordering Provider and Access to Their Radiology Reports

Cabarrus

Naeger

Rybkin

et al. 2015

Journal of the American College of Radiology

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“…However, in our prior work on determining delayed follow-up of abnormal laboratory (including TSH) and imaging results, we found that most instances without documented follow-up were truly instances where no follow-up occurred, as confirmed with the providers. 12,13,15 Second, due to limited resources, our study did not involve a review of trigger-negative records, precluding the ability to assess the trigger's negative predictive value, sensitivity, or specificity. However, the use of the trigger still allowed us to identify 163 delays in care that otherwise would not have been found.…”

Section: Discussionmentioning

confidence: 99%

“…12 However, their use has not eliminated follow-up delays, even when health care providers acknowledge receipt of notifications, a technological limitation of EHRs. 13 Indeed, our prior work revealed that 7-8% of EHR-based abnormal test result notifications were not acted on within 4 weeks. 14,15 Cognitive limitations of providers also contribute to delays in followup: for example, providers are often unable to discern relevant versus irrelevant information when assessing the need for follow-up while also dealing with information overload and alert fatigue.…”

Section: Introductionmentioning

confidence: 99%

Electronic Detection of Delayed Test Result Follow-Up in Patients with Hypothyroidism

et al. 2017

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BACKGROUND: Delays in following up abnormal test results are a common problem in outpatient settings. Surveillance systems that use trigger tools to identify delayed follow-up can help reduce missed opportunities in care. OBJECTIVE: To develop and test an electronic health record (EHR)-based trigger algorithm to identify instances of delayed follow-up of abnormal thyroid-stimulating hormone (TSH) results in patients being treated for hypothyroidism. DESIGN: We developed an algorithm using structured EHR data to identify patients with hypothyroidism who had delayed follow-up (>60 days) after an abnormal TSH. We then retrospectively applied the algorithm to a large EHR data warehouse within the Department of Veterans Affairs (VA), on patient records from two large VA networks for the period from January 1, 2011, to December 31, 2011. Identified records were reviewed to confirm the presence of delays in follow-up. KEY RESULTS: During the study period, 645,555 patients were seen in the outpatient setting within the two networks. Of 293,554 patients with at least one TSH test result, the trigger identified 1250 patients on treatment for hypothyroidism with elevated TSH. Of these patients, 271 were flagged as potentially having delayed follow-up of their test result. Chart reviews confirmed delays in 163 of the 271 flagged patients (PPV = 60.1%). CONCLUSIONS: An automated trigger algorithm applied to records in a large EHR data warehouse identified patients with hypothyroidism with potential delays in thyroid function test results follow-up. Future prospective application of the TSH trigger algorithm can be used by clinical teams as a surveillance and quality improvement technique to monitor and improve follow-up.

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“…We previously identified ambiguity of responsibility for test result follow-up to be a key factor in failure to follow up abnormal results. 4 Several EHRs now use asynchronous alert notifications to transmit results, but providers often receive many other types of notifications in their electronic in-box. We found that primary care providers (PCPs) receive a mean of 57 alerts a day in an integrated delivery system's EHR, all with new information they need to process and/or act upon.…”

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confidence: 99%

Improving Test Result Follow-up through Electronic Health Records Requires More than Just an Alert

Sittig

Singh

2012

J GEN INTERN MED

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A recent American Medical Association report highlighted failures in communication of abnormal test results as an important but understudied facet of improving safety in ambulatory care. 1 Because many outpatient test results are not life-threatening and don't require verbal communication, health information technology (IT) has potential to reliably transmit result information in the fragmented outpatient setting. Thus, few will disagree that communication of abnormal test results is an obvious context where advantages of health IT will be observed.In this issue of JGIM, Callen et al. report the results of a timely systematic review of 19 studies that documented quantitative evidence of test results not followed up in ambulatory settings. 2 They found wide variation in abnormal results lacking follow-up: 7 % to 62 % for laboratory, and 1 % to 36 % for imaging tests. Although evidence of the effectiveness of electronic test management systems was limited, there was a general trend towards improved followup in electronic systems.In another article in this issue, El-Kareh et al. discuss the results of a randomized controlled trial that put electronic communication to the test. The authors studied the effectiveness of sending microbiology test result alerts via a secure, internal e-mail system to clinicians when results were finalized post-discharge. 3 They found better documented evidence of appropriate follow-up within 3 days in the intervention group (28 % vs. 13 % in controls). Neither group's laboratory follow-up rate was particularly encouraging.On the bright side, both studies used distinctly different research approaches to reach similar conclusions, i.e., application of information and communication technologies, such as electronic health records (EHRs) with alerting capability, can increase the likelihood of appropriate test result follow-up. In paper-based systems, evaluating evidence of follow-up is itself challenging. On the other hand, both articles remind us that using EHR-based technology by itself does not entirely solve the problem of failure to follow up test results. Callen et al., as well as others, have made a strong case for addressing these failures based on safety implications. Additionally, Stage 2 meaningful EHR use (slated for implementation in 2014) includes laboratory test result reporting criteria. Time is now ripe for novel approaches to understand and improve this complex problem.The use of technology in the complex healthcare system must take into context the social environment where technology is embedded. For example, Callen et al. found lack of clear policies and procedures in relation to test result follow-up. We previously identified ambiguity of responsibility for test result follow-up to be a key factor in failure to follow up abnormal results. 4 Several EHRs now use asynchronous alert notifications to transmit results, but providers often receive many other types of notifications in their electronic in-box. We found that primary care providers (PCPs) receive a mean of 57 ale...

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Timely Follow-up of Abnormal Diagnostic Imaging Test Results in an Outpatient Setting

Cited by 187 publications

References 37 publications

Patients Prefer Results From the Ordering Provider and Access to Their Radiology Reports

Patients Prefer Results From the Ordering Provider and Access to Their Radiology Reports

Electronic Detection of Delayed Test Result Follow-Up in Patients with Hypothyroidism

Improving Test Result Follow-up through Electronic Health Records Requires More than Just an Alert

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