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Research Paper |
a Division of Health Policy and Quality, Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center and Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX
b Baylor College of Medicine, Houston, TX
c Department of Radiology, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX.
* Correspondence and reprints: Hardeep Singh, MD, MPH, VA Medical Center (152), 2002 Holcombe Boulevard, Houston, TX 77030 (Email: hardeeps{at}bcm.tmc.edu).
Received for publication: 09/15/06; accepted for publication: 03/27/07.
Objective: Communication of abnormal test results in the outpatient setting is prone to error. Using information technology can improve communication and improve patient safety. We standardized processes and procedures in a computerized test result notification system and examined their effectiveness to reduce errors in communication of abnormal imaging results.
Design: We prospectively analyzed outcomes of computerized notification of abnormal test results (alerts) that providers did not explicitly acknowledge receiving in the electronic medical record of an ambulatory multispecialty clinic.
Measurements: In the study period, 190,799 outpatient visits occurred and 20,680 outpatient imaging tests were performed. We tracked 1,017 transmitted alerts electronically. Using a taxonomy of communication errors, we focused on alerts in which errors in acknowledgment and reception occurred. Unacknowledged alerts were identified through electronic tracking. Among these, we performed chart reviews to determine any evidence of documented response, such as ordering a follow-up test or consultation. If no response was documented, we contacted providers by telephone to determine their awareness of the test results and any follow-up action they had taken. These processes confirmed the presence or absence of alert reception.
Results: Providers failed to acknowledge receipt of over one-third (368 of 1,017) of transmitted alerts. In 45 of these cases (4% of abnormal results), the imaging study was completely lost to follow-up 4 weeks after the date of study. Overall, 0.2% of outpatient imaging was lost to follow-up. The rate of lost to follow-up imaging was 0.02% per outpatient visit.
Conclusion: Imaging results continue to be lost to follow-up in a computerized test result notification system that alerted physicians through the electronic medical record. Although comparison data from previous studies are limited, the rate of results lost to follow-up appears to be lower than that reported in systems that do not use information technology comparable to what we evaluated.
This article has been cited by other articles:
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  H. Singh, E. J. Thomas, L. A. Petersen, and D. M. Studdert Resident Supervision and the Electronic Medical Record--Reply Arch Intern Med, May 26, 2008; 168(10): 1118 - 1118. [Full Text] [PDF]
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 H. Singh, S. Sethi, M. Raber, and L. A. Petersen Errors in Cancer Diagnosis: Current Understanding and Future Directions J. Clin. Oncol., November 1, 2007; 25(31): 5009 - 5018. [Abstract] [Full Text] [PDF]
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H. Singh, E. J. Thomas, L. A. Petersen, and D. M. Studdert Medical Errors Involving Trainees: A Study of Closed Malpractice Claims From 5 Insurers Arch Intern Med, October 22, 2007; 167(19): 2030 - 2036. [Abstract] [Full Text] [PDF]
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