title: Potential impact of a computerized system to report late-arriving laboratory results in the emergency department.
abstract: BACKGROUND
  Results of some laboratory tests for Emergency Department (ED) patients return hours to days after the patient is discharged. Inadequate follow-up for these late-arriving results poses medical and legal risks. We have developed, but not yet implemented, a computerized system called the Automated Late-Arriving Results Monitoring System (ALARMS). ALARMS scans the hospital's laboratory and ED registration databases to generate an electronic daily log of all late-arriving abnormal laboratory results for ED patients.
  
  
  OBJECTIVE
  To determine the potential impact of ALARMS by assessing our ED's current quality of documented follow-up of late-arriving laboratory results.
  
  
  METHODS
  We applied ALARMS retrospectively, to find all abnormal late-arriving laboratory results returned between 5/1/96 and 4/30/98 for ED patients for the following three tests: serum lead levels, Chlamydia cultures, or urine pregnancy tests. Medical records were reviewed for documentation of follow-up, which was considered appropriate if a clinician noted the abnormal result and documented a follow-up plan within 1 week after the result became available. Medical records were also reviewed for any evidence of complications attributable to delayed or inadequate follow-up.
  
  
  RESULTS
  Over the 2-year study period, no appropriate follow-up was documented in 6/18 (33%) cases of elevated lead levels, 3/4 (75%) cases of late-arriving positive pregnancy tests, and 23/39 (59%) cases of positive Chlamydia cultures. One case of a positive Chlamydia culture, for which there was no documented follow-up, was associated with subsequent development of pelvic inflammatory disease.
  
  
  CONCLUSIONS
  Our current system of documented follow-up for late-arriving laboratory results has deficiencies. ALARMS, a computerized system of alerts for emergency physicians, has the potential to substantially improve documented follow-up of late-arriving laboratory results in the ED.
authors.affiliation: Division of Emergency Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. greenes@a1.tch.harvard.edu
authors.forename: D S
authors.initials: DS
authors.lastname: Greenes
authors.forename: G R
authors.initials: GR
authors.lastname: Fleisher
authors.forename: I
authors.initials: I
authors.lastname: Kohane
mesh_terms: D000359:Aftercare / Q000458:organization & administration*; D002690:Chlamydia Infections / Q000175:diagnosis; D002984:Clinical Laboratory Information Systems / Q000458:organization & administration*; D019411:Clinical Laboratory Techniques; D004636:Emergency Service, Hospital; D006776:Hospitals, Pediatric; D006801:Humans; D007755:Laboratories, Hospital / Q000458:organization & administration*; D007855:Lead Poisoning / Q000175:diagnosis; D011258:Pregnancy Tests; D015397:Program Evaluation; D012189:Retrospective Studies; D013997:Time Factors