Failure to Follow-Up Test Results for Ambulatory Patients: A Systematic Review
ABSTRACT Serious lapses in patient care result from failure to follow-up test results.
To systematically review evidence quantifying the extent of failure to follow-up test results and the impact for ambulatory patients.
Medline, CINAHL, Embase, Inspec and the Cochrane Database were searched for English-language literature from 1995 to 2010.
Studies which provided documented quantitative evidence of the number of tests not followed up for patients attending ambulatory settings including: outpatient clinics, academic medical or community health centres, or primary care practices.
Four reviewers independently screened 768 articles.
Nineteen studies met the inclusion criteria and reported wide variation in the extent of tests not followed-up: 6.8% (79/1163) to 62% (125/202) for laboratory tests; 1.0% (4/395) to 35.7% (45/126) for radiology. The impact on patient outcomes included missed cancer diagnoses. Test management practices varied between settings with many individuals involved in the process. There were few guidelines regarding responsibility for patient notification and follow-up. Quantitative evidence of the effectiveness of electronic test management systems was limited although there was a general trend towards improved test follow-up when electronic systems were used.
Most studies used medical record reviews; hence evidence of follow-up action relied upon documentation in the medical record. All studies were conducted in the US so care should be taken in generalising findings to other countries.
Failure to follow-up test results is an important safety concern which requires urgent attention. Solutions should be multifaceted and include: policies relating to responsibility, timing and process of notification; integrated information and communication technologies facilitating communication; and consideration of the multidisciplinary nature of the process and the role of the patient. It is essential that evaluations of interventions are undertaken and solutions integrated into the work and context of ambulatory care delivery.
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ABSTRACT: To determine physician perspectives about direct notification of normal and abnormal test results. We conducted a cross-sectional survey at five clinical sites in the US and Australia. The US-based study was conducted via web-based survey of primary care physicians and specialists between July and October 2012. An identical paper-based survey was self-administered between June and September 2012 with specialists in Australia. Of 1417 physicians invited, 315 (22.2%) completed the survey. Two-thirds (65.3%) believed that patients should be directly notified of normal results, but only 21.3% were comfortable with direct notification of clinically significant abnormal results. Physicians were more likely to endorse direct notification of abnormal results if they believed it would reduce the number of patients lost to follow-up (OR=4.98, 95%CI=2.21-1.21) or if they had personally missed an abnormal test result (OR=2.95, 95%CI=1.44-6.02). Conversely, physicians were less likely to endorse if they believed that direct notification interfered with the practice of medicine (OR=0.39, 95%CI=0.20-0.74). Physicians we surveyed generally favor direct notification of normal results but appear to have substantial concerns about direct notification of abnormal results. Widespread use of direct notification should be accompanied by strategies to help patients manage test result abnormalities they receive. Published by Elsevier Ireland Ltd.Patient Education and Counseling 02/2015; 167(6). DOI:10.1016/j.pec.2015.02.011 · 2.60 Impact Factor
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ABSTRACT: The translation of science to practice to policy for meaningful use of healthcare information system (HIS) is embedded in a complex milieu of meaningful, meaningless, non- and mis-use of the system by a variety of stakeholders seeking to manage the cost, quality, safety, and parity of healthcare. The problem of HIS use can be modeled as an ontology which encapsulates the core logic of use. The ontology includes the three components of translation, the four types of use, the key stakeholders, and the four basic outcomes. It is a comprehensive structured natural-language model which can be extended and refined. It is parsimonious and can be easily understood and interpreted by all the stakeholders. We argue that such a model is necessary to develop a roadmap for strengthening the meaningful use of HIS. In its absence meaningful use of HIS will be weak.SSRN Electronic Journal 01/2014; DOI:10.2139/ssrn.2408854
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ABSTRACT: Harmonisation is likely to be an important contributor to ensure high quality laboratory testing, thus potentially improving patient outcome. Efforts for harmonisation must be made in the total testing process, from test requesting to communication of the laboratory test results and its consequences to the patient. In this article, suggestions are given about what level of harmonisation is possible at the various steps of the testing process, who could be responsible for facilitating and monitoring the effects of harmonisation, and what are likely barriers to achieving harmonisation. Harmonisation can be achieved at local, national and international levels, and will be most challenging when it involves more than one profession as in the extra-analytical phases. Key facilitators will be laboratory associations, regulatory bodies and accreditation systems, whereas barriers are likely to be reimbursement systems or economic factors, opinion leaders and manufacturers. A challenge is to try to turn barriers into facilitators. Harmonisation effects can in most settings be monitored by external quality assurance organisations provided that schemes are expanded to cover all relevant steps and phases. We must combine our efforts, both within our profession as well as in cooperation with others, to achieve harmonisation of the total testing process, in the best interests of the patient.Clinica chimica acta; international journal of clinical chemistry 12/2013; 432. DOI:10.1016/j.cca.2013.12.005 · 2.76 Impact Factor