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IMPROVING PATIENT CARE

Improving Patient Care is a special section within Annals supported in part by the U.S. Department of Health and Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ). The opinions expressed in this article are those of the authors and do not represent the position or endorsement of AHRQ or HHS.

Patient Safety Concerns Arising from Test Results That Return after Hospital Discharge

Christopher L. Roy, MD; Eric G. Poon, MD, MPH; Andrew S. Karson, MD, MPH; Zahra Ladak-Merchant, BDS, MPH; Robin E. Johnson, BA; Saverio M. Maviglia, MD, MSc; and Tejal K. Gandhi, MD, MPH

19 July 2005 | Volume 143 Issue 2 | Pages 121-128

Background: Failure to relay information about test results pending when patients are discharged from the hospital may pose an important patient-safety problem. Few data are available on the epidemiology of test results pending at discharge or on physician awareness of these results.

Objective: To determine the prevalence, characteristics, and physician awareness of potentially actionable laboratory and radiologic test results returning after hospital discharge.

Design: Cross-sectional study.

Setting: Two tertiary care academic hospitals.

Patients: 2644 consecutive patients discharged from hospitalist services from February to June 2004.

Measurements: The main outcomes were the prevalence and characteristics of potentially actionable test results returning after hospital discharge, awareness of these results by inpatient and primary care physicians, and satisfaction of inpatient physicians with current systems for follow-up on test results. The authors prospectively collected data on test results pending at the time of discharge and, as results returned after discharge, surveyed hospitalists, junior residents, and primary care physicians about those results that were potentially actionable according to a physician-reviewer.

Results: A total of 1095 patients (41%) had 2033 test results return after discharge. Of these results, 191 (9.4% [95% CI, 8.0% to 11.0%]) were potentially actionable. Surveys were sent regarding 155 results, and 105 responses were returned. Of the 105 results in the surveys with responses, physicians had been unaware of 65 (61.6% [CI, 51.3% to 70.9%]); of these 65, they agreed with physician-reviewers that 24 (37.1% [CI, 25.7% to 50.2%]) were actionable and 8 (12.6% [CI, 6.4% to 23.3%]) required urgent action. Inpatient physicians were dissatisfied with their systems for following up on test results returning after discharge.

Limitations: The authors were unable to determine whether physicians' lack of awareness of test results returning after discharge was associated with adverse outcomes.

Conclusions: Many patients are discharged from hospitals with test results still pending, and physicians are often unaware of potentially actionable test results returning after discharge. Further work is needed to design better follow-up systems for test results returning after hospital discharge.

Editors' Notes Context Poor communication between inpatient and outpatient providers precedes many preventable adverse events that occur shortly after discharge. Contribution Forty-one percent of 2644 patients on the hospitalist services of 2 academic hospitals had pending laboratory or radiology results at discharge. Physician-reviewers deemed approximately 9% of these results potentially actionable. Physician surveys done 14 days after results were first available showed that physicians were unaware of many results and thought that about 13% of them required urgent action. Cautions Findings may not apply to nonacademic or nonhospitalist settings. Implications We need good integrated systems to assure follow-up of tests that are pending at discharge. –The Editors

 

Author and Article Information

From Brigham and Women's Hospital and Massachusetts General Hospital, Boston, Massachusetts.

Acknowledgments: The authors thank Mr. Justin Golden and Mr. Martin Spera.

Grant Support: By a grant from the Harvard Risk Management Foundation, Cambridge, Massachusetts.

Potential Conflicts of Interest: None disclosed.

Requests for Single Reprints: Christopher L. Roy, MD, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115; e-mail, croy{at}partners.org.

Current Author Addresses: Drs. Roy and Maviglia: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Drs. Poon and Gandhi, Ms. Ladak-Merchant, and Ms. Johnson: Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA 02120.

Dr. Karson: Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.

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