Test Result Management Key to Accurate and Timely Diagnosis
The failure to follow up on imaging, test and lab results is a widespread issue that continues to pose challenges to patient safety. As in years past, ECRI Institute named Missed and Delayed Diagnosis as one of its Top 10 Patient Concerns for 2020 and noted that mismanagement of test result have long been a primary contributing factor to errors in diagnosis.
Although the complexity of the diagnostic process means that many factors contribute to missed and delayed diagnoses, system factors such as test result management play a significant role. A 10-year analysis of 124,000 medical professional liability cases revealed that testing and results processing was a contributing factor in 32% of the 6,700 delayed diagnosis claims in the ambulatory setting. Thoughtfully designed test result management systems and policies encourage clear communication and patient participation, employ “closed loop” communication methodologies, and provide evidence of the practice’s efforts.
MIEC recommends the following:
- Set the stage: Advise patients of the timeframe in which they should expect to receive results and instruct them to follow up with your office if they have not heard back. Encourage patients to check for results on the patient portal or via other patient-facing technologies if available. Do not advise patients that “no news is good news.” Set the expectation that patients should be receiving a result; they can act as a failsafe in the event of a breakdown in test result management chain.
- Know what has been ordered and which results are outstanding: Create a “tickler system” to track ordered labs, tests, and specialist consultations. This can be done electronically via tasked workflows in an EHR, or via a simple paper log listing the patient name and identifier, the referral, the date referred, date report is received, and follow-up action taken. Staff members can monitor the log to ensure that results are received in a timely fashion. When results are not received in a timely fashion, determine the cause. Perhaps the result was sent to the wrong office. Perhaps the patient never obtained the test as directed. If the latter, an informed refusal discussion may be warranted.
- Evidence of review: When results and reports are received, ensure that there is evidence of clinician review of the information, either electronically signed or otherwise noted in the EHR or physically initialed on the paper copy prior to it being filed in the patient chart.
- Notification of results: Document what patients are told, when, by whom, and any follow-up instructions. We recommend that only licensed healthcare providers notify patients of positive or abnormal results. If results are to be discussed with the patient at their next visit, be sure to note whether the appointment is canceled or rescheduled, as it may be necessary to call the patient with results to ensure timely follow up.
- Consider people, processes, and technology. The most effective test management system for your practice will depend on many factors, including the type of care provided and tests ordered, the demographics of your patient population, and the availability of personnel and technology. As with any patient safety system, a good way to improve and refine is to pay attention to patient complaints and even “near misses” to identify potential vulnerabilities.
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ECRI Top 10 Patient Safety Concerns for 2020
ECRI institute Test Tracking and Follow-Up Toolkit