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Clinical Decisionmaking

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Following up on abnormal test results is challenging for busy doctors who view hundreds of results a week

Failure to follow up on an abnormal test result not only jeopardizes a patient's health, it also may lead to malpractice claims. This presents a serious and challenging problem for busy doctors, some of whom review as many as 800 pieces of chemistry or hematology data, 40 radiology reports, and 12 pathology reports a week. For example, in a recent survey, 83 percent of doctors said that they had reviewed at least one test result in the preceding 2 months that they wished they had known about earlier. Nearly one in five primary care doctors said that this type of delay had happened five or more times during the previous 2 months.

Despite spending an average of 74 minutes per day reviewing test results, informing patients about results, and developing followup plans (and in many cases designating a staff member to screen test results for abnormalities), only 41 percent of doctors were satisfied with how they managed test results. Only 52 percent of physicians surveyed kept a record of tests ordered, and just 32 percent reported having a system to detect whether a patient had missed a test. For instance, only 39 percent had a mechanism to ensure that a patient with a marginally abnormal mammogram received a followup mammogram within 6 months.

Most physicians said they would welcome tools to help them generate test result letters to patients, prioritize their workflow, and track test orders to completion, according to researchers from Brigham and Women's Hospital, Nashville VA Medical Center, and Massachusetts General Hospital.

In the study, which was supported in part by the Agency for Healthcare Research and Quality (HS11046), the researchers surveyed 168 physicians working in 15 internal medicine practices affiliated with two large urban teaching hospitals about their test result review systems, time spent and satisfaction with managing test results, delays in reviewing results, and desired features in a new test result management system. Brigham and Women's Hospital and Massachusetts General Hospital now use an electronic system that collects patients' test results in one place, similar to an E-mail in-box. The system highlights abnormal results, so that the doctor can review them first.

For more information, see "I wish I had seen this test result earlier!" by Eric G. Poon, M.D., M.P.H., Tejal K. Gandhi, M.D., M.P.H., Thomas D. Sequist, M.D., and others, in the November 8, 2004, Archives of Internal Medicine 164, pp. 2223-2228.

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