Some Docs Fail to Tell Patients About Critical Results 25% of Time

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PRIMARY CARE PHYSICIANS often do not report patients’ lab test results, according to a recent study of 5,434 patients aged 50 to 69. That won’t be news to most lab directors and pathologists.

But there is something new and useful in this study. Its findings are revealing for three reasons. One, it involves a large sample size of patients. Two, it is believed to be the first study to estimate the “failure to inform” rate across a variety of laboratory tests and types of practice. Three, this research represents continued progress toward holding physicians accountable to take the appropriate steps to produce an accurate diagnosis and report test results promptly to patients.

Study leader was Lawrence P. Casalino, M.D., Ph.D., MPH, Division Chief in the Department of Public Health at Weill Cornell Medical College, in New York City. “Frequency of Failure to Inform Patients of Clinically Significant Outpatient Test Results,” was published on June 22 in The Archives of Internal Medicine.

In the case of failure to inform patients of clinically significant abnormal test results or failure to document that the patients were informed, the average rate was 7.14%, or 1 of every 14 tests. However, the failure rate varied from 0% to 26%, or as many as one in four tests! One interesting finding is that those medical practices using what’s called a partial electronic medical record system (meaning a combination of paper and electronic records), had the highest failure rates of reporting test results to patients.

By contrast, researchers did not find a significant difference between practices that had a complete EMR and those that used paper records. Another study finding is that most practices did not use all of the relatively simple processes suggested in the literature as basic to managing test results. In particular, most practices did not have explicit rules for notifying patients about results and many told patients that—if they did not learn about their test results—they should assume that “no news is good news.”

Improving Patient Safety

This study by Casalino and his colleagues about how often physicians fail to report critical results to the patient or document that the patient was notified is a welcome development for the lab testing profession. It shows how the focus on patient safety, now firmly entrenched in the hospital setting, is now beginning to raise its profile in physician office settings.

As well, this study supports the developing effort to hold physicians accountable for diagnostic errors. As reported earlier this year, physicians at Johns Hopkins showed that diagnostic errors— including missed, wrong, or delayed diagnoses—account for 40,000 to 90,000 deaths annually, (See TDR, April 6, 2009.)

Laboratory administrators and pathologists should welcome clinical studies of this sort. These are early efforts to address deficiencies in the pre analytical and post-post analytical steps (outside the laboratory), where physicians often fail to use laboratory test results to the maximum benefit of patients.

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