Effective communication & management of test results

Posted 2nd December 2016 by Jane Williams

The World Alliance for Patient Safety has identified poor test result management as a high priority patient safety area. Evidence-based reviews have shown that pathology and imaging test results fail to be followed up in 20% to 62% of inpatients, and in up to 75% of patients treated in an emergency department [1]. Poor test result follow-up can have major consequences for quality of care, including missed diagnoses and sub-optimal patient outcomes.

An investigation by the Clinical Excellence Commission in New South Wales, Australia in 2011 showed that 11% (3/27) of reported clinical incidents resulting in serious harm (e.g., patient death), and 32% (24/75) of clinical incidents with major consequences for patients, were related to poor test follow-up [2]. The urgency of the problem was highlighted by the US Emergency Care Research Institute’s 2014 report on patient safety concerns for health care organisations. The report listed data integrity failures associated with health information systems, poor care coordination across levels of care and test result reporting problems as the leading three items of their top 10 patient safety concerns for 2014 [3].

Addressing test result follow-up involves attention to a number of interconnected issues including:

• The establishment of effective test result management systems in hospitals using clear guidelines and standards for test result follow-up;
• Harnessing information technology to better manage the communication of results;
• The contribution of consumers to the test management process.

Clear guidelines and standards for test result follow-up
Pathology and medical imaging services perform a major role in the delivery of patient care by ensuring reliable and accurate results are delivered in a timely fashion to inform clinical management decisions. One of the main sources of problems in the communication of test result information occurs once a test result has been issued to the requesting (or referring) doctor. Errors in this reporting phase of the laboratory process are often a consequence of the absence of clear definitions about what are critical, unexpected or significantly abnormal results.

There is also a lack of consensus among laboratories, medical imaging departments, hospitals and other health care settings about when and how these results should be communicated to the responsible medical officer. This was highlighted by a 2012 survey of test result management in Australian laboratories, which revealed large variations in how critical results are managed and the lack of agreed standards or guidelines [4]. Good practice recommendations in this area emphasise the importance of clear definitions of key terms and the need for agreed alert thresholds and time frames and specified procedures for fail-safe communication of test results that pose a critical or significant risk to patient safety [5].

Harnessing information technology
Information technology (IT) has a key role to play in the communication and follow-up of test results. However, new models of test management supported by IT can only succeed when they are able to address the clinical governance challenges associated with safe test management. Effective solutions must engage all stakeholders to arrive at decisions about who needs to receive the test results, how and when the results are communicated, and how they are acknowledged and acted upon. Meeting these challenges requires the establishment of robust and resilient partnerships between managers, clinicians, pathology and medical imaging departments, and must include the involvement of patients.

Enhancing the contribution of consumers in the test management process
According to the US National Patient Safety Foundation [6] and the Australian Commission on Safety and Quality in Health Care [7] the benefits of increased consumer engagement include safer and better health care. It is particularly relevant to test result follow-up where failure to inform patients of their results has been described as legally indefensible in malpractice claims. Electronic health records can be used to allow consumers to access their own information using a secure electronic patient portal, which in addition to allowing access to appointment and personal information, also facilitates communication with health professionals.

However, there are major obstacles which hinder the involvement of consumers, including a lack of educational tools and guides that can help consumers to manage their own care, including about when it may be necessary to seek medical assistance [6].

Professor Andrew Georgiou is leading an Australian National Health and Medical Research Council Partnership Grant with the Australian Commission on Safety and Quality in Health Care and the South Eastern Area Laboratory Services, NSW Health Pathology. If you’d like to know more, you can email him or follow him on Twitter.

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References:

1. Callen J, Georgiou A, Li J, Westbrook J. The safety implications of missed test results for hospitalized patients: a systematic review. BMJ Qual Saf. 2011; 20:194-9.
2. Clinical Excellence Commission. Clinical Focus Report: Diagnostic tests – How access and follow-up affect patient outcomes Sydney, Australia: Clinical Excellence Commission; 2012.
3. ECRI Institute. ECRI Institute’s top 10 patient safety concerns for healthcare organizations. Available at: www.ecri.org/EmailResources/PSRQ/Top10/Top10PSRQ.pdf 2014.
4. Campbell C, Horvath A. Towards Harmonisation of Critical Laboratory Result Management-Review of the Literature and Survey of Australasian Practices. Clin Biochem Rev. 2012;33(4):149.
5. Georgiou A, Lymer S, Forster M, et al. Lessons learned from the introduction of an electronic safety net to enhance test result management in an Australian mothers’ hospital. J Am Med Inform Assoc. 2014;21:1104-8.
6. The National Patient Safety Foundation. Safety is personal; Partnering with patients and families for the safest care. Available at: http://www.npsf.org/about-us/lucian-leape-institute-at-npsf/lli-reports-and-statements/safety-is-personal-partnering-with-patients-and-families-for-the-safest-care/ (Accessed: 30 May). 2014.
7. Australian Commission on Safety and Quality in Health Care (ACSQHC). National Safety and Quality Health Service Standards. Sydney, Australia: Commonwealth of Australia; 2012.

Tags: communication, pathology