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3 in 4 hospital tests not followed up

Failure to follow up tests after discharge seriously puts patients at risk

Ingrid Torjesen

Tuesday, 08 February 2011

As many as three in four tests conducted on patients while they are in hospital are not followed up once the patient has been discharged, suggests a review published in BMJ Quality and Safety.

Not only is this failure to follow through with the results of tests a waste of money, it can also have serious implications for patients, including missed or delayed diagnoses and even death, the paper shows.

The Australian researchers analysed 12 studies published between 1990 and 2010, which indicated that between 20% and 61% of inpatient test results, and between 1% and 75% of tests on patients treated in emergency care, were not followed up after discharge.

Critical test results and results for patients moving between healthcare settings, such as from inpatient to outpatient care or to general practice, were most likely not to be pursued.

The rate of failure to follow up on tests conducted was high whether paper-based systems were used, a mix of paper and electronic records, and in the two studies which used electronic test management systems alone.

Associate Professor Joanne Callen of the Centre for Health Systems and Safety Research at the University of New South Wales in Sydney, suggested that rates were high when electronics systems were used because the technology made the problem more explicit and easier to measure.

In 2008, the World Alliance for Patient Safety identified poor test follow-up as one of the key processes leading to unsafe patient care, and seven of the 12 studies looking at the impact on patients reveals that consequences include  missed or delayed diagnoses of infectious disease and cancer, inappropriate or unnecessary antibiotic prescriptions, and even death.

One of the studies looked at by the Australian researchers, which assessed clinical negligence claims, found that almost two thirds involved missed diagnoses in emergency care settings that ended up harming the patient. In 13 of the 79 claims, the broken link in the chain occurred when the test results were either transmitted to, or received by, the care provider.

Professor Callen said: “There is evidence to suggest that the proportion of missed test results is a substantial problem, which impacts on patient safety,” conclude the authors.

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