What’s New in the Patient Safety World
July 2015
Technology to Avoid Delays in Follow-up of Significant Results
One of the most egregious errors in healthcare is failure to follow up on significant test results. These may be results of bloodwork, other laboratory tests, pathology studies, imaging studies, and other diagnostic tests.
In our October 13, 2009 Patient Safety Tip of the Week “Slipping Through the Cracks” we highlighted a study that showed almost 8% of patients with critical imaging results had not received appropriate follow-up within 4 weeks (Singh 2009).
Researchers from that same group have now developed and
validated a “trigger” tool to detect such delays in treatment for patients
having abnormal results of lung imaging studies (Murphy 2015).
The researchers developed an electronic health record (EHR) algorithm based
upon reports of chest CT images and/or conventional chest radiography that had
been read as “suspicious for malignancy”. The algorithm excluded patients in
whom appropriate and timely follow up had taken place (such as a pulmonary
visit) or cases in which no follow up was necessary (eg.
patients with terminal illness). The
trigger algorithm was retrospectively applied to the records of over 89,000
patients. Of 538 records with an imaging report that was flagged as suspicious
for malignancy, 131 were identified by the trigger as being high risk for
delayed diagnostic evaluation. Manual chart reviews were then done and
confirmed a true absence of follow-up in 75 cases, of which four received a
diagnosis of primary lung cancer within the subsequent 2 years. The positive
predictive value (PPV) for the trigger was thus 57.3% for detecting evaluation
delays. The researchers now plan to apply the trigger tool prospectively.
We clearly need ways
to ensure that patients with significant imaging (or lab) findings have had
appropriate follow-up. Phone calls and emails may be cumbersome if they need to
be made on all patients with such findings. However, using trigger tools such
as the one described here can filter down the list of cases needing such phone
calls or email follow-ups can go a long way to ensuring no one “falls through
the cracks”.
See also our other
columns on communicating significant results:
- Patient Safety Tip of the Week May 1, 2007 “The Missed Cancer”
- Patient Safety Tip of the Week February 12, 2008 “More on Tracking Test Results”
- Patient Safety Tip of the Week October 13, 2009 “Slipping Through the Cracks”
- What’s New in the Patient Safety World July 2009 “Failure to Inform Patients of Clinically Significant Outpatient Test Results
- Patient Safety Tip of the Week March 9, 2010 “Communication of Urgent or Unexpected Radiology Findings”
- Patient
Safety Tip of the Week March 1, 2011
“Tests
Pending at Discharge”
- Patient
Safety Tip of the Week August 21,
2012 “More
on Missed Followup of Tests in Hospital”
- What’s
New in the Patient Safety World
October 2013 “New
AHRQ Toolkit: Improving Your Office Testing Process”
- What’s
New in the Patient Safety World
January 2014 “Email
Alerts for Pending Test Results”
References:
Singh H, Thomas EJ, Mani S, et al. Timely Follow-up of Abnormal Diagnostic Imaging Test Results in an Outpatient Setting. Arch Intern Med. 2009; 169(17): 1578-1586
http://archinte.jamanetwork.com/article.aspx?articleid=224747
Murphy DR, Thomas EJ, Meyer AND, Singh H. Development and Validation of Electronic Health Record–based Triggers to Detect Delays in Follow-up of Abnormal Lung Imaging Findings. Radiology 2015; published ahead of print May 11, 2015
http://pubs.rsna.org/doi/abs/10.1148/radiol.2015142530
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