Failure to Inform Patients of Abnormal Test Results

  1. From the Archives of Internal Medicine:

    [FONT=verdana, arial, helvetica, sans-serif] Background Failing to inform a patient of an abnormal outpatient test result can be a serious error, but little is known about the frequency of such errors or the processes for managing results that may reduce errors.

    [FONT=verdana, arial, helvetica, sans-serif]Methods We conducted a retrospective medical record review of 5434 randomly selected patients aged 50 to 69 years in 19 community-based and 4 academic medical center primary care practices. Primary care practice physicians were surveyed about their processes for managing test results, and individual physicians were notified of apparent failures to inform and asked whether they had informed the patient. Blinded reviewers calculated a "process score" ranging from 0 to 5 for each practice using survey responses.
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    [FONT=verdana, arial, helvetica, sans-serif]Results The rate of apparent failures to inform or to document informing the patient was 7.1% (135 failures divided by 1889 abnormal results), with a range of 0% to 26.2%. The mean process score was 3.8 (range, 0.9-5.0). In mixed-effects logistic regression, higher process scores were associated with lower failure rates (odds ratio, 0.68; P < .001). Use of a "partial electronic medical record" (paper-based progress notes and electronic test results or vice versa) was associated with higher failure rates compared with not having an electronic medical record (odds ratio, 1.92; P = .03) or with having an electronic medical record that included both progress notes and test results (odds ratio, 2.37; P = .007).
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    [FONT=verdana, arial, helvetica, sans-serif]Conclusions Failures to inform patients or to document informing patients of abnormal outpatient test results are common; use of simple processes for managing results is associated with lower failure rates.

    The entire article is available at:

    http://archinte.ama-assn.org/cgi/con...ll/169/12/1123

    If you just want to read the table of what tests were looked at and the results:

    http://archinte.ama-assn.org/cgi/data/169/12/1123/DC1/1

    One interesting quote: "[FONT=verdana, arial, helvetica, sans-serif]To our knowledge, no guidelines exist to delineate the processes that practices should use to manage test results." To which I say, "Why not?".

    I'm sure many of us (including me) have had the experience of finding out that a significant test result was not communicated to us. It has turned me into one of those patients who call and inquire about the test result if I don't hear anything from the dr.'s office.

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    About AtomicWoman

    Joined: Jul '07; Posts: 1,775; Likes: 1,180

    13 Comments

  3. by   cursedandblessed
    i find it actually a little shocking, i guess i'm used to good care.

    my husband's and my pcp's in the same practice, send us out a hard copy of our chemistry and cbc and cholesterol results with a short note hand written at the bottom something like total cholesterol elevated at 213 but your good cholesterol is high. recommendations: continue to eat diet with lean meats, fresh vegies & fruits and limit sugar.

    my pap smear results are mailed out on a form letter, stating pap smear normal, recommend recheck in 2 years (blanks for the normal/abnormal space, and for how much time before a recheck). for abnormals we're telephoned and recheck/redraw appointments are made, and we get the letters. how difficult is that??

    i get a letter directly from the hospital regarding my mammogram (with a freaking bright yellow smiley face on it-how professional is that?) telling me it's normal, and to come back next year as yearly screenings are a woman's best way for early detection. i get a shower card too.

  4. by   nerdtonurse?
    I've seen it where labs spit off the printer 2 days after the pt's been discharged from the hospital. Since the patient's been discharged, there's no established method of us telling the MD of an abnormal result -- no chart to flag, no way for us to formally interact. And since the labs like that tend to come off at 0200 with the big nightly batch job, it strictly depends on the US who pulls the lab and realizes the pt's been discharged also recognizing a dangerous lab value and bringing it to the attention of a nurse, who may or may not give a rip, since it's not our patient anymore, and some nurses say it's against HIPAA to even read it, much less alert the doc, since there's no long a nurse/pt relationship. If I see a lab come back, and it's abnormal, I try to call the doc. Sometimes, I've taped the lab (folded over, with "Attn: Dr. X" on the note") to the MD computer in their cubby.

    I've also seen people where the doc knew they had cancer (esophageal, colon, not something palapable by the pt like breast ca) who were sent home without ever being told they were sick. That's a bad day to be a nurse.
  5. by   steelcityrn
    I have had this happen to myself. This article was about time! Maybe its time for all patients to be treated with respect.
  6. by   gt4everpn
    I think this is absurd, every patient should be notified of their labs results whether good or bad, when I go to my doctor he goes over the abnormal test results with me, if there are any, and generally we would discuss the solutions etc.. This should be a violation of patient rights.
  7. by   AtomicWoman
    Quote from nerdtonurse?
    I've also seen people where the doc knew they had cancer (esophageal, colon, not something palapable by the pt like breast ca) who were sent home without ever being told they were sick. That's a bad day to be a nurse.
    OMG. I had no idea...
  8. by   AtomicWoman
    Here's a problem I've noticed. You see the doc, s/he gives you a lab slip to get your cholesterol tested, or your bood glucose, or whatever. No one in the office notes that you got the lab slip anywhere except maybe in your chart, which gets filed away after your visit. No one knows they should be expecting a report from the lab, so if/when a report goes missing and/or does not show up, no one knows it's missing. The patient thinks everything is OK, since they haven't heard any bad news, and the medical staff is clueless that the person actually had the test done and they need to follow up and get the report. Gee whiz, a simple tickler file would eliminate most of this problem, but medical practices don't routinely institute simple processes like that.
  9. by   emmalou*
    Quote from nerdtonurse?
    I've seen it where labs spit off the printer 2 days after the pt's been discharged from the hospital. Since the patient's been discharged, there's no established method of us telling the MD of an abnormal result -- no chart to flag, no way for us to formally interact. And since the labs like that tend to come off at 0200 with the big nightly batch job, it strictly depends on the US who pulls the lab and realizes the pt's been discharged also recognizing a dangerous lab value and bringing it to the attention of a nurse, who may or may not give a rip, since it's not our patient anymore, and some nurses say it's against HIPAA to even read it, much less alert the doc, since there's no long a nurse/pt relationship. If I see a lab come back, and it's abnormal, I try to call the doc. Sometimes, I've taped the lab (folded over, with "Attn: Dr. X" on the note") to the MD computer in their cubby.

    I've also seen people where the doc knew they had cancer (esophageal, colon, not something palapable by the pt like breast ca) who were sent home without ever being told they were sick. That's a bad day to be a nurse.
    Waaa???!! Doctors have a legal duty of care to inform patients of abnormal test results! Much less knowing they have a serious medical condition and not informing them?? I am horrified by this. It would be grounds for medical malpractice IMO. If I was the nurse in the situation, I would be elevating it to administration quite frankly. Even if the patient has been discharged, surely there's follow up with the specialist or their general practitioner who can advise them? I really don't understand this.

    The poster who said they get letters in the mail re: test results - that's amazing service. In Australia when I see my general practitioner for bloods, PAP smears etc, I am advised to phoned them for results which I do, however they are legally obliged to advise me of the results one way or the other. My husband's GP practice always phones him however, within a few days.
  10. by   Mollypita
    I've seen this numerous times in my 1.5 years as a Med-Surg nurse. And the instances of doctors taking their time notifying patients of results is even more common. I might see results on a Friday, for instance, and the patient starts asking about the results that night. Of course, I can't tell them even though I know the answer to their question, and the doctor doesn't address it the next day, or maybe even the following day!! Very frustrating. I've also seen a similar situation (working on an oncology floor) of cancer spreading to other organs, and patients not being told until it's too late. Knowing you have colon cancer is one thing, but still you think a patient would want to know that it's spread to their liver! Ughhhh! Like nerdtonurse said, not a pleasant day to be a nurse.
  11. by   oramar
    At one hospital I worked people failed to get results of problematic test so often that they had a nurse in charge of reviewing all in patient and out patient test. Their job was to check all test and made sure docs were aware of them and notified the patient. In-patient nurses were NOT responsible for calling test results on discharged patient as that was considered a hipaa violation and was a hit and miss thing at best. They watched blood cultures very closely. Boy you had better call those blood cultures into doc in timely manner.
    Last edit by oramar on Jun 24, '09
  12. by   momandstudent
    I had an incident of this with my daughter when she was about 1 1/2. I had taken her to the doctor for an upper respiratory cold. Doc told me he was going to do an RSV test just to rule it out. Told me he would call if anything was abnormal. He prescribed her an antibiotic and a week later, I took her back into him as her cough had not gotten better. He said,"Well, with RSV, the cough will linger for a while." I said, "What, RSV?" Doc: "Didn't I call you with the results? I suppose you've been doing daycare this whole time, haven't you?" Sure had, had 6-8 other children come into contact with it. Luckily, nobody else got it but it really ticked me off.
  13. by   libra32547
    Wow, I can believe this is some aspect. I having been on the other end of this, I worked as a lab tech for the last 5 years. The person who runs and reports all the lab results. Where I work, we of course have a policy of reporting critical results. This is the general flow of it for INPATIENTS. If I have a critical potassium of 2.8 that I (as the lab tech) have 30 minutes to call it to the CHARGE NURSE of that floor. The charge nurse has to actually go into the computer, annotate that she has received it, then her clock starts ticking, she has I think 30 minutes to call it to the MD and annotate it in the computer. Of course, this system hasn't always been what we have done, but after all the tweaking and working the bugs out of old systems, this has worked the best according to all those fancy and colorful PI charts supervisors make. And it is documented from start to finish who resulted the lab, what time, who called, who received it...ect.

    Now for outpatiens, we call the doctors office, and give it to whoever will take it...secretary, ma, cma...whoever. After that we (at the lab) can't track it because, all our computer systems arent linked together, but we do record in our computer who we gave it to. Now, if it's after hours, that is a different story because we have to call the MD on call for that practice and give it directly to him.

    As far as a MD not telling a patient about cancer, or other pathology type specimens...thats crazy. I know our pathologist's call all positive cancer biopsies to the actual MD and that get's put in the computer, what MD they notified and what time.

    These days, its all about CYA (Cover Your A**) and documentation. Even from a lab perspective.
  14. by   horselover1
    Every patient should be notified of the results. Sometimes clinics are a little slow, I had a guy call today needing his results from a procedure done in early may!

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