June 22, 2009
If you had a medical test that came back with bad news, you'd want to know, wouldn't you?
Well, according to a report in the June 22 issue of Archives of Internal Medicine, many primary care doctors and their staff are failing to give patients the word — or at least are not documenting that they have informed them.
There are many steps in the testing process, which extends from ordering a test to providing appropriate follow-up; an error in any one of these steps can have deadly consequences.
Researchers at Weill Cornell Medical College in New York reviewed the medical records of 5,434 randomly selected patients in 23 primary care practices. From those, they selected patients with a clinically significantly abnormal result on one of 11 blood tests or three screening tests commonly performed on an outpatient basis.
These records were then assessed for an indication that he or she had been informed about the abnormal result. In cases for which there was no evidence such communication occurred, doctors were sent a form telling them about the apparent oversight and giving them the opportunity to correct the record if the patient had been informed or to inform the patient at that time.
In addition, physicians responded to a six-question survey about the processes for managing test results at their practices and their satisfaction with these processes. Reviewers calculated a score ranging from zero to five for each practice, with five indicating that they closely followed five steps ranging from routing results to the responsible physician to asking patients to call after a certain time period if they had not been notified of the results.
The reviewers identified 1,889 abnormal test results and 135 apparent failures to inform the patient or to document informing the patient — a rate of 7.1 percent, or about one of every 14 tests.
"Failure rates varied widely among practices, from 0 percent to 26 percent; practices that used better processes to manage results had lower failure rates and had physicians who were more satisfied with the processes used," the authors write.
Practices that used a combination of paper and electronic records — a so-called partial electronic medical record — had the highest failure rates, whereas there was no significant difference between practices that used complete electronic medical records or paper records.
"Some elements of medical care (e.g., diagnosis) are an art as well as a science, depend heavily on the cognitive skills and effort of individual physicians, involve much uncertainty and will probably always have relatively high error rates," the authors conclude. "However, notifying patients of test results does not appear to be such a process; with appropriate within-practice systems, low rates of failure to inform should be possible."
