2011 HSR&D National Meeting Abstract
3053 — Improving Follow-up of Abnormal Test Results: Evaluating the Impact of a “Mandatory” Notification
Laxmisan A (Baylor College of Medicine), Sittig DF
(The University of Texas Health Science Center at Houston), Espadas D
(Houston VA HSR&D Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center), Singh H
(Houston VA HSR&D Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center)
Concerns about timely follow-up of abnormal imaging and lab test results remain despite electronic notifications to providers. On March 11, 2009, a national CPRS change was implemented that required all pathology results (normal or abnormal) to be transmitted to ordering providers via CPRS-based automated notifications that cannot be switched off by providers (mandatory “view alerts”). We examined the impact of this intervention on follow-up of abnormal pathology results in the outpatient setting.
We conducted retrospective chart reviews to evaluate pre- and post-intervention follow-up outcomes at two large VA facilities. We electronically extracted all pathology reports in a six-month time-frame before and after the date of intervention. From 16,738 pre-intervention and 17,305 post-intervention reports at two sites, we randomly selected 688 and 706 abnormal outpatient reports, respectively. Trained reviewers collected follow-up outcomes using a standardized pre-tested data collection instrument, on all possible acceptable follow-up actions for up to six-months post alert transmission. These actions included documentation of ordering or performance of an appropriate follow-up test or referral, prescribing or changing treatment, patient contact, subsequent hospitalization where the report was addressed, or other documentation of appropriate provider-recognition (e.g., noting patient preference to decline or to seek follow-up elsewhere). Reviewers also categorized actions as direct or indirect, depending on whether they could clearly link the action directly to the report. Outcome measures included proportion of abnormal reports with lack of any follow-up within six-months and median time to direct follow-up action pre- and post-intervention.
Post intervention, the proportion of reports without follow-up decreased significantly (9.8% vs. 3.5% p < 0.01). Median time to direct follow-up action was unchanged (8 days (IQR 5-15 days) vs. 8 days IQR (5-14 days) p = 0.6).
Mandatory notification of abnormal pathology results did not lead to fail-safe follow-up at six-months or prompt earlier follow-up actions by ordering providers.
Interventions other than making test result alerts mandatory in CPRS are needed to ensure direct follow-up actions on patients’ abnormal pathology results in the outpatient setting. These interventions should be designed by addressing the several socio-technical factors that contribute to patient safety in a complex environment.