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Cassell BE, Walker T, Alghamdi S, Bill J, Blais P, Boutté H, Brown JW, Sayuk GS, Gyawali CP. Do Consultants Follow Up on Tests They Recommend? Insights from an Academic Inpatient Gastrointestinal Consult Service. Dig Dis Sci 2017; 62:1448-1454. [PMID: 28391419 PMCID: PMC5890923 DOI: 10.1007/s10620-017-4563-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/30/2017] [Indexed: 12/09/2022]
Abstract
BACKGROUND Inpatient care is a fundamental part of gastroenterology training and involves the recommendation, performance, and interpretation of diagnostic tests. However, test results are not always communicated to patients or treating providers. We determined the process of communication of test results and recommendations in our inpatient gastroenterology (GI) consult service. METHODS Test recommendations on 304 consecutive new GI consults (age 60.2 ± 1.0 year) over a 2-month period were recorded. Demographic factors (age, race, gender, zip code, insurance status) were extracted from the electronic medical record (EMR). Charts were independently reviewed 6 months later to determine results of recommended tests, follow-up of actionable test results, 30-day readmission rates, and predictors of suboptimal communication. RESULTS Of 490 recommended tests, 437 (89.2%) were performed, and 199 (45.5%) had actionable findings. Of these, 48 (24.1%) did not have documented follow-up. Failure of follow-up was higher for upper endoscopy (31.9%) compared to colonoscopy (18.0%, p = 0.07). Women (p = 0.07), patients on Medicare (p = 0.05), and procedures supervised by advanced GI fellows (p = 0.06) were less likely to receive follow-up. Median income and identification of a primary provider did not influence follow-up rates; 30-day readmission rates were not impacted. Female gender, insurance (Medicare) status, and attending type remained independent predictors of failure of follow-up on multivariate regression (p ≤ 0.03). CONCLUSIONS Failure to follow up test results on inpatient services at a large academic center was unacceptably high. Maximizing personnel participation together with diligence and technology (EMR) will be required to improve communication.
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Affiliation(s)
- Benjamin E. Cassell
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA,Division of Gastroenterology and Hepatology, University of Colorado, 1055 Clermont St MS 111-E, Denver, CO 80218, USA
| | - Ted Walker
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA
| | - Saad Alghamdi
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jason Bill
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA
| | - Pierre Blais
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA
| | - Harold Boutté
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey W. Brown
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA
| | - Gregory S. Sayuk
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA,Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA,John Cochran VA Medical Center, St. Louis, MO, USA
| | - C. Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA
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Hayes SA, Breen M, McLaughlin PD, Murphy KP, Henry MT, Maher MM, Ryan MF. Communication of Unexpected and Significant Findings on Chest Radiographs With an Automated PACS Alert System. J Am Coll Radiol 2014; 11:791-5. [DOI: 10.1016/j.jacr.2014.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
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Callen J, Georgiou A, Li J, Westbrook JI. The safety implications of missed test results for hospitalised patients: a systematic review. BMJ Qual Saf 2011; 20:194-9. [PMID: 21300992 PMCID: PMC3038104 DOI: 10.1136/bmjqs.2010.044339] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Failure to follow-up test results is a critical safety issue. The objective was to systematically review evidence quantifying the extent of failure to follow-up test results and the impact on patient outcomes. METHODS The authors searched Medline, CINAHL, Embase, Inspec and the Cochrane Database from 1990 to March 2010 for English-language articles which quantified the proportion of diagnostic tests not followed up for hospital patients. Four reviewers independently reviewed titles, abstracts and articles for inclusion. RESULTS Twelve studies met the inclusion criteria and demonstrated a wide variation in the extent of the problem and the impact on patient outcomes. A lack of follow-up of test results for inpatients ranged from 20.04% to 61.6% and for patients treated in the emergency department ranged from 1.0% to 75% when calculated as a proportion of tests. Two areas where problems were particularly evident were: critical test results and results for patients moving across healthcare settings. Systems used to manage follow-up of test results were varied and included paper-based, electronic and hybrid paper-and-electronic systems. Evidence of the effectiveness of electronic test management systems was limited. CONCLUSIONS Failure to follow up test results for hospital patients is a substantial problem. Evidence of the negative impacts for patients when important results are not actioned, matched with advances in the functionality of clinical information systems, presents a convincing case for the need to explore solutions. These should include interventions such as on-line endorsement of results.
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Affiliation(s)
- Joanne Callen
- Centre for Health Systems and Safety Research, The University of New South Wales, Sydney NSW 2052, Australia.
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Hanna D, Griswold P, Leape LL, Bates DW. Communicating Critical Test Results: Safe Practice Recommendations. Jt Comm J Qual Patient Saf 2005; 31:68-80. [PMID: 15791766 DOI: 10.1016/s1553-7250(05)31011-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Massachusetts hospitals have collaborated in a patient safety initiative conducted by the Massachusetts Coalition for the Prevention of Medical Errors and the Massachusetts Hospital Association which is aimed at improving the ability to communicate critical test results in a timely and reliable way to the clinician who can take action. Solutions to this problem would address enhancing communication, teamwork, and information transfer, all fundamental system factors linked to patient safety. DEVELOPING THE SAFE PRACTICE RECOMMENDATIONS AND THE "STARTER SET": A Coalition-convened Consensus Group defined critical test results as values/interpretations for which reporting delays can result in serious adverse outcomes for patients. The scope included laboratory, cardiology, radiology, and other diagnostic tests in inpatient, emergency, and ambulatory settings. The Consensus Group developed Safe Practice Recommendations to promote successful communication of results, and a "starter set" of test results sufficiently abnormal to be widely agreed to be considered "critical." DISSEMINATION The recommendations and the starter set of test results were disseminated in a statewide collaborative open to all Massachusetts hospitals. Hospitals' team members tested changes and shared successful strategies that improved the reliability of communicating critical test results. An evaluation of the results of this collaborative is underway.
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Affiliation(s)
- Doris Hanna
- Massachusetts Coalition for the Prevention of Medical Errors, Boston, USA.
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