Failure to follow up on inpatient test results is common
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A significant percentage of tests performed in the hospital are not followed up, according to a new systematic review.
The review included 12 studies, eight of which were conducted in the U.S, all of which quantified the proportion of diagnostic tests that were performed on inpatients but not pursued. The review found wide variation. For admitted patients, 20.04% to 61.6% of tests were not followed up, corresponding to 1% to 22.9% of patients.
There was even greater variation in follow-up on tests performed in the emergency department, with estimates ranging from 1% to 75% of tests not followed up, or 0% to 16.5% of patients. Several studies observed serious negative outcomes resulting from the failure to follow up, including missed cancer diagnoses. The review was published online by BMJ Quality and Safety on Feb. 7.
The review authors noted particular problems with critical test results, which were apparently lost to follow up due to communication breakdowns, including noncompliance with guidelines calling for results to be phoned to practitioners. Patients who moved across health care settings, for example from inpatient to outpatient or from the emergency department to another setting, also posed challenges for follow-up. This finding highlights the “need for systems, policies and practices which facilitate communication of information across different settings,” the study authors said.
The review also looked at the role of various medical records systems, but found no evidence of any association between the type of record system used and follow-up of test results. Electronic, paper, and mixed electronic/paper systems all had high rates of missed results. Electronic systems that can be accessed by clinicians in and out of the hospital and those that include a function for clinicians to endorse results may be helpful, but they would require further study, and should be combined with other strategies. Test result management systems should be flexible and integrated into clinical work practices, the review authors concluded.