Background: Approximately 10-15% of diagnoses are incorrect and poor follow-up of critical diagnostic tests has been identified as a major preventable cause of this problem. Missed test results may impact negatively on patient outcomes and lead to repeat testing: both of which have quality and cost implications. Computerised provider order entry (CPOE) systems allow physicians to order tests and review results on-line. In spite of the potential of CPOE in reducing missed results the utilization of on-line test result acknowledgement features in these systems is under-utilized. There have been no published literature reviews on the extent of missed results and limited studies on the role of information technology in addressing this problem. The objectives of our research were to: 1) assess the evidence regarding the extent and impact of missed test results for hospital patients (Study 1), and 2) explore Emergency Department (ED) physicians’ perceptions, practices and suggestions for improvements of test result follow-up when using a CPOE system (Study 2).
Methods: Study 1: English language articles from Medline, CINAHL, Embase, Inspec and Cochrane Database from 1990 to 2010 which quantified the proportion of diagnostic tests not followed-up for hospital patients were reviewed. Study 2: In-depth interviews with ED physicians were conducted in a 400 bed public teaching hospital which used a commercial CPOE system to order and view all diagnostic and radiology tests.
Results: Study 1: Twelve studies met the inclusion criteria. Lack of follow-up for inpatients ranged from 29% to 61.6% and for ED patients from 1.0% to 75%. Impact on patient outcomes included missed diagnoses of malignancy. Two key areas where problems were evident were follow-up of critical results and management of results for patients moving across care settings. Systems used to follow-up results varied between paper based, electronic and hybrid paper and electronic systems. Study 2: Physicians perceived key issues which impacted on follow-up were: responsibility for test follow-up and the role of the family physician in the test follow-up process; the unique ED environment; time pressures, and the combination of manual and electronic test management practices.
Conclusion: The problem of missed test results and the impact on patients is considerable. Studies to examine the effectiveness of on-line endorsement and patient involvement in the test result follow-up process are required. ED physicians’ with access to a CPOE system with limited test management features which excluded online endorsement, develop workarounds.
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