Although test results don’t trigger the same types of dramatic alarms and sirens found in some healthcare situations, tracking results should be regarded as a critical patient safety function.
As evidence of this, ECRI Institute’s Executive Brief on the 2019 Top 10 Patient Safety Concerns named diagnostic stewardship and test result management using electronic health records (EHRs) as number one on its list of concerns. This ranking is especially compelling because the analysis included 2.8 million patient safety events over a 10-year period.1
Test result management in ambulatory practices can pose a significant challenge for physicians and practice managers. To be fully successful, tracking test results requires a standardized workflow. Missed or delayed diagnosis leading to serious injury or death can occur if standard workflow is not established for the testing process.
In a systematic review of the influence of information technology (IT) on managing laboratory tests in primary care, findings suggested some positive and negative impacts. Positive impacts of IT use included easier access to results, reduced turnaround times, and more frequent testing using evidence-based guidelines. Negative impacts included cognitive overload with the potential for increased medical error when electronic and paper-based processes are used simultaneously. Additionally, some systems were simply not deemed user-friendly, affecting the clinician’s performance. Lastly, when workflow wasn’t fully established, the reliance on the prescriber’s memory led to a potential for errors.2
Findings from 424 patient safety risk assessments performed by The Doctors Company revealed that issues related to test tracking were identified in 14 percent of assessed practices. The most common finding was that practices depended on passively waiting for test results or for the patient to return before checking the result. Additional issues included lack of provider review before filing test results in the chart and delays in ordering or failure to order diagnostic tests, leading to delayed or missed diagnoses.3 These findings are further evidence of the continuing challenges associated with test-tracking standardization in physician office practices.
The goal of every practice is to provide optimal care to patients. Although tracking methods can differ depending on many variables in the practice setting, effectively managing patient care always includes steps to ensure result reconciliation, physician review, patient notification, and a follow-up plan of care.
A fully established process incorporates a standard workflow that includes the following components:
Implementing a standardized test-tracking system can create job satisfaction for those responsible for the process. Physicians can be reassured that test results are handled appropriately and that patients are more involved in their own care. Most importantly, the potential for patient harm will be reduced and liability avoided.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.