Statement of problem: Failure to follow-up test results increases the risk of diagnoses being missed or delayed which impacts on clinical outcomes for patients. Electronic health records which include integrated test management systems allow clinicians to electronically order tests and review results on-line. Limited research has been conducted on whether these systems can reduce missed results. A key capability of electronic test management systems is the test result endorsement function. This allows clinicians to acknowledge test results electronically and document their follow-up actions including communication of the result to patients. To date there have been no published studies evaluating this function. This presentation will report the development of a detailed research protocol investigating the impact of on-line endorsement using a multi-method approach in two hospitals. The aims are to describe on-line result endorsement work processes and assess the effectiveness of this function in reducing missed results, and improving patient outcomes and the efficiency of clinicians’ work.
Description of the intervention or program: Intervention: An on-line test result endorsement function which allows doctors to acknowledge test results and document follow-up actions electronically. Using a controlled before and after design, study 1 will measure whether the intervention reduces the rate of missed test results and improves patient outcomes. Population: Microbiology and radiology test results of patients discharged from three clinical units (ED, general ward, rheumatology clinic) in each of two study hospitals. Outcomes: Abnormal test results not reviewed prior to patient’s discharge or within a recommended timeframe for ambulatory patients; abnormal test results not reviewed judged to have potentially influenced patient management, and results not reported to the family physician. Study 2 will assess whether and how test management technology changes doctors’ and nurses’ work. A qualitative design using interviews (n=44), focus groups (n=6) and observations (32 hours) will explore: how satisfied clinicians are and barriers to the integration of on-line endorsement into everyday test management practices.
Findings to date: The development of this protocol has involved considerable background research to describe current and new test management work processes which will be required with the new system functionality. This has included understanding the variability in test management practices between specialist areas.
Lessons learned: The resulting research protocol highlights important features which need to be considered in evaluating the new role technology plays in reliable result management. This is the first documented study of its type and is of value to an international audience tackling this aspect of improved diagnosis in medicine.
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