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

Abstract

Objective The management and follow-up of diagnostic test results is a major patient safety concern. The aim of this qualitative study was to explore how clinicians manage test results on an everyday basis (work-as-done) in a health information technology–enabled emergency department setting. The objectives were to identify (1) variations in work-as-done in test results management and (2) the strategies clinicians use to ensure optimal management of diagnostic test results. Materials and Methods Qualitative interviews (n = 26) and field observations were conducted across 3 Australian emergency departments. Interview data coded for results management (ie, tracking, acknowledgment, and follow-up), and artifacts, were reviewed to identify variations in descriptions of work-as-done. Thematic analysis was performed to identify common themes. Results Despite using the same test result management application, there were variations in how the system was used. We identified 5 themes relating to electronic test results management: (1) tracking test results, (2) use and understanding of system functionality, (3) visibility of result actions and acknowledgment, (4) results inbox use, and (5) challenges associated with the absence of an inbox for results notifications for advanced practice nurses. Discussion Our findings highlight that variations in work-as-done can function to overcome perceived impediments to managing test results in a HIT-enabled environment and thus identify potential risks in the process. By illuminating work-as-done, we identified strategies clinicians use to enhance test result management including paper-based manual processes, cognitive reminders, and adaptive use of electronic medical record functionality. Conclusions Test results tracking and follow-up is a priority area in need of health information technology development and training to improve team-based collaboration/communication of results follow-up and diagnostic safety.

Defining Diagnostic Error: A Scoping Review to Assess the Impact of the National Academies’ Report Improving Diagnosis in Health Care

“…Although concepts related to communication of a diagnosis to the patient comparatively have not been as well studied or operationalized, there is a growing body of literature related to timely communication of abnormal test results. For instance, a large number of studies have identified lack of timely communication of abnormal test results to patients and provided specific metrics with which to measure and improve the process 40–48 . Additional work is needed to study how factors related to information, timing, method, and behaviors play an integral role in communication in the context of the diagnostic process 28,29 .…”

“…For instance, a large number of studies have identified lack of timely communication of abnormal test results to patients and provided specific metrics with which to measure and improve the process. [40][41][42][43][44][45][46][47][48] Additional work is needed to study how factors related to information, timing, method, and behaviors play an integral role in communication in the context of the diagnostic process. 28,29 An increased emphasis on patient-partnered or patient-oriented diagnostic research and the application of interdisciplinary research from fields outside of medicine can provide knowledge on how to measure and improve diagnostic communication.…”

Why is there variation in test ordering practices for patients presenting to the emergency department with undifferentiated chest pain? A qualitative study

“…Detailed data collection and analysis of the larger dataset are reported elsewhere. 10 Patients were not involved in this study.…”

The Role of Electronic Medical Records in Reducing Unwarranted Clinical Variation in Acute Health Care: Systematic Review

“…At the same time, EMRs can also create variation by offering users multiple ways to perform a task. Work-as-done by clinicians also often varies from the work-as-imagined expectation of EMR designers [ 23 ]; as a result, it is an empirical question as to whether EMRs actually reduce unwarranted clinical variation.…”