Lessons learned from implementation of a computerized application for pending tests at hospital discharge.
BACKGROUND
Patients are often discharged from the hospital before test results are finalized. Awareness of these results is poor and therefore an important patient safety concern. Few computerized systems have been deployed at care transitions to address this problem. We describe an attempt to implement a computerized application to help inpatient physicians manage these test results.


METHODS
We modified an ambulatory electronic medical record (EMR)-based results management application to track pending tests at hospital discharge (Hospitalist Results Manager, HRM). We trained inpatient physicians at 2 academic medical centers to track these tests using this application. We surveyed inpatient physicians regarding usage of and satisfaction with the application, barriers to use, and the characteristics of an ideal system to track pending tests at discharge.


RESULTS
Of 29 survey respondents, 14 (48%) reported never using HRM, and 13 (45%) used it 1 to 2 times per week. A total of 23 (79%) reported barriers prohibiting use, including being inundated with clinically "irrelevant" results, not having sufficient time, and a lack of integration of post-discharge test result management into usual workflow. Twenty-one (72%) wanted to receive notification of abnormal and clinician-designated pending test results. Twenty-seven physicians (93%) agreed that an ideally designed computerized application would be valuable for managing pending tests at discharge.


CONCLUSIONS
Although inpatient physicians would highly value a computerized application to manage pending tests at discharge, the characteristics of an ideal system are unclear and there are important barriers prohibiting adoption and optimal usage of such systems. We outline suggestions for future electronic systems to manage pending tests at discharge.
Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA. adalal1@partners.org
Anuj K
AK
Dalal
Eric G
EG
Poon
Andrew S
AS
Karson
Tejal K
TK
Gandhi
Christopher L
CL
Roy
D000046:Academic Medical Centers; D003266:Continuity of Patient Care; D003955:Diagnostic Tests, Routine; D057286:Electronic Health Records; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D010351:Patient Discharge; D010865:Pilot Projects