Communication Outcomes of Critical Imaging Results in a Computerized Notification System
- Affiliations of the authors: Division of Health Policy and Quality, Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center and Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX; Baylor College of Medicine, Houston, TX; Department of Radiology, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX
- Correspondence and reprints: Hardeep Singh, MD, MPH, VA Medical Center (152), 2002 Holcombe Boulevard, Houston, TX 77030; e-mail: <hardeeps{at}bcm.tmc.edu>
- Received 15 September 2006
- Accepted 27 March 2007
Abstract
Objective Communication of abnormal test results in the outpatient setting is prone to error. Using information technology can improve communication and improve patient safety. We standardized processes and procedures in a computerized test result notification system and examined their effectiveness to reduce errors in communication of abnormal imaging results.
Design We prospectively analyzed outcomes of computerized notification of abnormal test results (alerts) that providers did not explicitly acknowledge receiving in the electronic medical record of an ambulatory multispecialty clinic.
Measurements In the study period, 190,799 outpatient visits occurred and 20,680 outpatient imaging tests were performed. We tracked 1,017 transmitted alerts electronically. Using a taxonomy of communication errors, we focused on alerts in which errors in acknowledgment and reception occurred. Unacknowledged alerts were identified through electronic tracking. Among these, we performed chart reviews to determine any evidence of documented response, such as ordering a follow-up test or consultation. If no response was documented, we contacted providers by telephone to determine their awareness of the test results and any follow-up action they had taken. These processes confirmed the presence or absence of alert reception.
Results Providers failed to acknowledge receipt of over one-third (368 of 1,017) of transmitted alerts. In 45 of these cases (4% of abnormal results), the imaging study was completely lost to follow-up 4 weeks after the date of study. Overall, 0.2% of outpatient imaging was lost to follow-up. The rate of lost to follow-up imaging was 0.02% per outpatient visit.
Conclusion Imaging results continue to be lost to follow-up in a computerized test result notification system that alerted physicians through the electronic medical record. Although comparison data from previous studies are limited, the rate of results lost to follow-up appears to be lower than that reported in systems that do not use information technology comparable to what we evaluated.
Footnotes
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Presented in part as an abstract at the Annual Meeting of the Society of General Internal Medicine, Toronto, Canada, April 26, 2007.
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Dr. Singh is the recipient of National Institutes of Health K12 Mentored Clinical Investigator Award grant number K12RR17665 to Baylor College of Medicine. Dr. Petersen is a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar (grant number 045444) and a recipient of the American Heart Association Established Investigator Award (grant number 0540043N). These sources had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, and approval of the manuscript or the decision to submit the manuscript for publication. Dr. Singh had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
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The authors thank Carol Swartsfager for her assistance with figures and Annie Bradford for assistance with technical writing.
