Tracking patient follow up and diagnostic test results

This article is available as a CME course and is published in the Reporter Q3 2019.

Introduction

Tracking patient follow up and diagnostic test results can be challenging tasks for a number of reasons. Patient non-compliance, heavy workloads, multiple care providers, and the lack of systems or tools to facilitate timely follow up are potential hurdles to overcome. But initiating and maintaining strong follow up and communication policies and procedures can go a long way toward enhancing quality patient care.

Issues with managing test results

A recent study conducted by the Canadian Medical Protective Association of closed claims found that failure to follow up on test results or diagnostic imaging reports was one of the most frequent issues identified in claims, including “delay in follow up, no follow up, or inadequate processes for follow up.” ¹

The study identified the following areas for improvement:

booking or ordering diagnostic tests recommended by a physician;
following up on patients who cancel or fail to show up for an appointment;
following up when results from a completed test are not received;
date stamping and initialing reports as they are received in an office;
mandating that all reports be read completely so all key information is acknowledged;
flagging reports for physician review before filing;
flagging abnormal results;
identifying patients who require urgent or routine follow up;
communicating test results to patients and others, such as referring physicians or other care providers;
scanning or placing test results into patient files; and
arranging for continued care when a physician retires, moves, or leaves for an extended period, such as family leave or vacation. ¹

The study provided the caveat that many of these cases involved several physicians, facilities, and hospitals. For example, one case involved a system tracking issue with both a hospital and a physician’s office. Tracking test results can become even more problematic when multiple facilities, institutions, and providers become involved.¹

TMLT risk managers listed “tracking of test results” as one of the top five recommendations given to policyholders, based on data collected from practice reviews conducted in 2017 and 2018. While test tracking options have improved with the use of electronic health records (EHRs), practices are not always taking advantage of available tracking systems.

A 2017 report by the U.S. Emergency Care Research Institute named “poor care coordination across levels of care and test-result reporting problems” among their top 10 patient-safety concerns for 2017. ²

A 2018 study by the World Alliance for Patient Safety (WHO) identified poor test-result management as a high priority patient-safety area, with pathology and imaging test results management again noted as especially problematic. According to this research, pathology and imaging test results fail to be followed up between 20% and 62% of inpatients. The rate is even higher for patients treated in the emergency department — 75%. ²

The study stated that errors most often occurred in communicating test results between the laboratory and the requesting provider. These errors are “often due to a lack of agreed standards or guidelines among laboratories, medical imaging departments, hospitals and other healthcare settings about what are critical, unexpected or significantly abnormal results, and when and how these results should be communicated to the responsible clinician.” ²

Additional research from a hospital in Sydney, Australia showed that tests ordered on the day of patient discharge accounted for 47% of missed test results. This raised questions about the necessity and appropriateness of ordering tests of which results are most likely never reviewed.

Many of these issues can be remedied by establishing a clear system for communicating with outside facilities, that address mutually agreed upon communication standards, including:

what needs to be expedited and what does not;
when to communicate test results;
how to communicate with the ordering provider including up-to-date contact information; and
a structured procedure for communicating critical test results.

While the ordering physician is ultimately responsible for the timely follow up of diagnostic tests, it is recommended to institute a system in your office for tracking test results to ensure results are received and communicated in a timely manner. This includes reporting results to patients and planning appropriate follow up.

Read the entire article and reference sources in the Reporter Q3 2019. Upon completion of the article and CME course, physicians will be able to: