One of our continuing hot buttons is results of significant clinical findings slipping through the cracks. We discussed these extensively in our May 1, 2007 Patient Safety Tip of the Week “The Missed Cancer” and our February 12, 2008 Patient Safety Tip of the Week “More on Tracking Test Results”.
A new paper sheds some light on the frequency with which such failures to inform patients about clinically significant tests occur. Casalino et al reviewed charts from both community and academic primary care practices to find documentation of followup of abnormal results of 11 common blood tests and 3 common preventive tests. They found apparent failure to inform patients of such abnormal test results 7.1% of the time. Perhaps the most interesting finding is that those practices using a combination of paper and electronic records (so called “partial EMR”) had higher failure rates than those having either a full EMR or full paper-based systems. They found that very few practices had explicit rules or systems for managing test results and usually relied on the individual physician to devise his/her own system. Unfortunately, some were still telling patients to rely on the old “no news is good news” concept, which obviously is very flawed and unsafe.
This entire issue remains problematic and better systems are needed to ensure such abnormal test results do not slip through the cracks. Further research is needed to develop the evidence base for best practices in this regard.
Update: See also our October 13, 2009 Patient Safety Tip of the Week “Slipping Through the Cracks”.
Casalino LP, Dunham D, Chin MH et al. Frequency of Failure to Inform Patients of Clinically Significant Outpatient Test Results. Arch Intern Med. 2009;169(12):1123-1129.