Researchers looked at how physicians in ambulatory settings followed up on the results of medical laboratory tests
Studies performed in the United States show that, for ambulatory patients, doctors fail to follow up on as many as two-thirds of medical laboratory test results and up to one-third of radiology reports! A recent review of 19 of these studies also showed that these failures resulted in serious lapses in patient care.
It was researchers at the University of New South Wales (UNSW) who undertook a systematic review of evidence of failure to follow up on diagnostic test results and how this impacted ambulatory patients. The review was the first of its kind, internationally, according to a story published on UNSW’s Australian Institute of Health Innovation (AIHI) website.
Failure to Follow Up on Results of Clinical Laboratory Tests
“Failure to follow-up [on medical laboratory and radiology] test results for patients is a critical safety issue which requires urgent attention,” declared lead researcher Joanne L. Callen, Ph.D., in a story published by Medical Xpress. “Without knowledge of the size and effect of the problem, many clinicians may underestimate its extent and consequences.” Callen is an Associate Professor at UNSW and works as a Senior Research Fellow in the Centre for Health Systems and Safety Research. The Journal of General Internal Medicine published the review article.
The research team examined 19 studies that were conducted in the United States, where most of the research is being done, according to Callen. The U.S. studies quantified the extent of the failure to follow up clinical laboratory and radiology tests. Settings included ambulatory patients attending outpatient clinics, academic medical centers, community health centers, and primary care practices.
The investigators found that doctors in the United States fail to follow up as many as 62% of clinical pathology laboratory tests and up to 35% of radiology reports. This means that they are missing critical diagnoses. In turn, this causes delays in treatments for many conditions, including cancer, the AIHI story stated.
The 19 studies included in the review reported a wide variation in the extent of diagnostic tests not followed up by the ordering physician. For medical laboratory tests, results varied from 6.8% (79/1163) to 62% (125/202). For radiology, the results varied from 1.0% (4/395) to 35.7% (45/126), according to the review abstract.
Studies Showed Improved Test Follow Up With Use of Electronic Systems
The practices and processes currently used are varied and unsystematic, the review authors wrote. They noted that most primary care practices are not using electronic health record (EHR) systems. Further, they stated that most are communicating with multiple clinical laboratories that are often not electronically connected.
“Quantitative evidence of the effectiveness of electronic test management systems was limited,” the authors observed in the abstract. However, they found that “there was a general trend towards improved test follow up when electronic systems were used.”
The researchers also pointed out that feedback on medical errors is essential in order to counteract overconfidence in decision making vis-à-vis diagnostic accuracy. “Without knowledge of the size of the problem, many clinicians may underestimate its extent and therefore fail to take any action to improve the process,” they stated in the abstract.
The researchers concluded that solutions to the problem of missed diagnostic test results require a multi-faceted approach. Their recommendations included addressing the following areas:
- policies relating to responsibility, timing and process of notification;
- integrated IT and communications technologies;
- consideration of the multidisciplinary nature of the process; and,
- the role of the patient as a possible safety net against error.
Pathologists Can Read the Original UNSW Paper
Pathologists and clinical laboratory managers may want to access the original paper published by Callen and her colleagues. The paper’s statistics and findings may be useful in educating physicians about why failure to follow up on medical laboratory test results is a bigger problem than currently acknowledged.
In fact, publication of this study creates another opportunity for medical laboratories to add value to clinicians by helping them avoid missing key lab test results that might be overlooked. Such assistance is particularly important at a time when an important component of physician reimbursement is based on improvement in patient outcomes.
—Pamela Scherer McLeod