title: Performance of a fail-safe system to follow up abnormal mammograms in primary care.
abstract: OBJECTIVE
  Missed and delayed breast cancer diagnoses are major sources of potential harm to patients and medical malpractice liability in the United States. Follow-up of abnormal mammogram results is an essential but challenging component of safe breast care. To explore the value of an inexpensive method to follow up abnormal test results, we examined a paper-based fail-safe system.
  
  
  METHODS
  We examined a fail-safe system used to follow up abnormal mammograms at a primary care practice at an urban teaching hospital. We analyzed all abnormal mammogram reports and clinicians' responses to follow-up reminders. We characterized potential lapses identified in this system and used regression models to identify patient, provider, and test result characteristics associated with such lapses.
  
  
  RESULTS
  Clinicians responded to fail-safe reminders for 92% of 948 abnormal mammograms. Clinicians reported that they were unaware of the abnormal result in 8% of cases and that there was no follow-up plan in place for 3% of cases. Clinicians with more years of experience were more likely to be aware of the abnormal result (odds of being unaware per incremental year in practice, 0.92; 95% confidence interval, 0.88-0.97) and were more likely to have a follow-up plan.
  
  
  CONCLUSIONS
  A paper-based fail-safe system for abnormal mammograms is feasible in a primary care practice. However, special care is warranted to ensure full clinician adherence and address staff transitions and trainee-related issues.
authors.affiliation: Division of General Internal Medicine, New York University School of Medicine, New York, NY, USA. ellie.grossman@med.nyu.edu
authors.forename: Ellie
authors.initials: E
authors.lastname: Grossman
authors.forename: Russell S
authors.initials: RS
authors.lastname: Phillips
authors.forename: Saul N
authors.initials: SN
authors.lastname: Weingart
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003266:Continuity of Patient Care / Q000592:standards*; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D011320:Primary Health Care; D017010:Reminder Systems / Q000592:standards; D012307:Risk Factors; D011795:Surveys and Questionnaires