Crossing the finish line: follow-up of abnormal test results in a multisite community health center.
BACKGROUND
Inadequate follow-up of abnormal test results is a common safety problem in outpatient practice. However, it is unclear exactly where and how often failures occur in the results management process. Our goal was to determine where breakdowns occur by examining 4 high-risk abnormal test results in a group of 11 clinics of an urban community health center organization.


METHODS
Using a chart audit, we counted failures in the management of abnormal results of 4 tests: Pap smears, mammograms, international normalized ratio (INR), and prostate-specific antigen (PSA). We assessed documentation that the result was filed in the chart; the provider signed and responded to the result; the patient was notified of the result; the appropriate follow-up occurred, and it occurred in a timely manner or there was explicit patient refusal of the recommended follow-up.


RESULTS
There were 344 abnormal test results (105 Pap smears, 82 mammograms, 61 INRs, and 96 PSAs). The highest rate of failures in the management process was at follow-up care; 34% of the abnormal results did not have documentation that appropriate follow-up had occurred (11% for mammography, 26% for INR, 45% for Pap smears, and 46% for PSA). All of the earlier steps were performed with far fewer failures. For patients receiving follow-up care, 49% of the time, follow-up care did not occur in a timely manner.


CONCLUSIONS
Most breakdowns in the testing process for these 4 abnormal tests were in the final step, documenting that appropriate follow-up care occurred. Office systems for managing abnormal results reporting and patient follow-up are needed to improve the safety and quality of care.
Chen
Eric T
ET
Pritzker School of Medicine, University of Chicago, Chicago, Illinois USA.
Eder
Mickey
M
Elder
Nancy C
NC
Hickner
John
J
D001943:Breast Neoplasms / Q000517:prevention & control; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003151:Community Health Centers; D003266:Continuity of Patient Care; D003955:Diagnostic Tests, Routine; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008327:Mammography; D065006:Papanicolaou Test; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000517:prevention & control; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control; D014626:Vaginal Smears
D017430:Prostate-Specific Antigen