Frequency of failure to inform patients of clinically significant outpatient test results.
BACKGROUND
Failing to inform a patient of an abnormal outpatient test result can be a serious error, but little is known about the frequency of such errors or the processes for managing results that may reduce errors.


METHODS
We conducted a retrospective medical record review of 5434 randomly selected patients aged 50 to 69 years in 19 community-based and 4 academic medical center primary care practices. Primary care practice physicians were surveyed about their processes for managing test results, and individual physicians were notified of apparent failures to inform and asked whether they had informed the patient. Blinded reviewers calculated a "process score" ranging from 0 to 5 for each practice using survey responses.


RESULTS
The rate of apparent failures to inform or to document informing the patient was 7.1% (135 failures divided by 1889 abnormal results), with a range of 0% to 26.2%. The mean process score was 3.8 (range, 0.9-5.0). In mixed-effects logistic regression, higher process scores were associated with lower failure rates (odds ratio, 0.68; P < .001). Use of a "partial electronic medical record" (paper-based progress notes and electronic test results or vice versa) was associated with higher failure rates compared with not having an electronic medical record (odds ratio, 1.92; P = .03) or with having an electronic medical record that included both progress notes and test results (odds ratio, 2.37; P = .007).


CONCLUSIONS
Failures to inform patients or to document informing patients of abnormal outpatient test results are common; use of simple processes for managing results is associated with lower failure rates.
Casalino
Lawrence P
LP
Department of Public Health, Weill Cornell Medical College, New York, NY 10065-6304, USA. lac2021@med.cornell.edu
Dunham
Daniel
D
Chin
Marshall H
MH
Bielang
Rebecca
R
Kistner
Emily O
EO
Karrison
Theodore G
TG
Ong
Michael K
MK
Sarkar
Urmimala
U
McLaughlin
Margaret A
MA
Meltzer
David O
DO
D000368:Aged; D019411:Clinical Laboratory Techniques / Q000592:standards*; D003627:Data Interpretation, Statistical; D005568:Forms and Records Control / Q000592:standards*; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control / Q000592:standards*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010045:Outpatients; D012189:Retrospective Studies; D012308:Risk Management / Q000379:methods*; D014481:United States