Failure to Follow-Up Test Results for Ambulatory Patients: A Systematic ReviewReport as inadecuate

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Journal of General Internal Medicine

, Volume 27, Issue 10, pp 1334–1348

First Online: 20 December 2011Received: 29 July 2011Revised: 28 September 2011Accepted: 04 November 2011ABSTRACT

BACKGROUNDSerious lapses in patient care result from failure to follow-up test results.

OBJECTIVETo systematically review evidence quantifying the extent of failure to follow-up test results and the impact for ambulatory patients.

DATA SOURCESMedline, CINAHL, Embase, Inspec and the Cochrane Database were searched for English-language literature from 1995 to 2010.

STUDY SELECTIONStudies which provided documented quantitative evidence of the number of tests not followed up for patients attending ambulatory settings including: outpatient clinics, academic medical or community health centres, or primary care practices.

DATA EXTRACTIONFour reviewers independently screened 768 articles.

RESULTSNineteen studies met the inclusion criteria and reported wide variation in the extent of tests not followed-up: 6.8% 79-1163 to 62% 125-202 for laboratory tests; 1.0% 4-395 to 35.7% 45-126 for radiology. The impact on patient outcomes included missed cancer diagnoses. Test management practices varied between settings with many individuals involved in the process. There were few guidelines regarding responsibility for patient notification and follow-up. Quantitative evidence of the effectiveness of electronic test management systems was limited although there was a general trend towards improved test follow-up when electronic systems were used.

LIMITATIONSMost studies used medical record reviews; hence evidence of follow-up action relied upon documentation in the medical record. All studies were conducted in the US so care should be taken in generalising findings to other countries.

CONCLUSIONSFailure to follow-up test results is an important safety concern which requires urgent attention. Solutions should be multifaceted and include: policies relating to responsibility, timing and process of notification; integrated information and communication technologies facilitating communication; and consideration of the multidisciplinary nature of the process and the role of the patient. It is essential that evaluations of interventions are undertaken and solutions integrated into the work and context of ambulatory care delivery.

KEY WORDSpatient safety test result follow-up medical errors primary care quality improvement  Download fulltext PDF

Author: Joanne L. Callen - Johanna I. Westbrook - Andrew Georgiou - Julie Li


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