Skip to main content

Advertisement

SpringerLink
Log in

Impact of Automated Alerts on Follow-Up of Post-Discharge Microbiology Results: A Cluster Randomized Controlled Trial

  • Original Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

ABSTRACT

BACKGROUND

Failure to follow up microbiology results pending at the time of hospital discharge can delay diagnosis and treatment of important infections, harm patients, and increase the risk of litigation. Current systems to track pending tests are often inadequate.

OBJECTIVE

To design, implement, and evaluate an automated system to improve follow-up of microbiology results that return after hospitalized patients are discharged.

DESIGN

Cluster randomized controlled trial.

SUBJECTS

Inpatient and outpatient physicians caring for adult patients hospitalized at a large academic hospital from February 2009 to June 2010 with positive and untreated or undertreated blood, urine, sputum, or cerebral spinal fluid cultures returning post-discharge.

INTERVENTION

An automated e-mail-based system alerting inpatient and outpatient physicians to positive post-discharge culture results not adequately treated with an antibiotic at the time of discharge.

MAIN MEASURES

Our primary outcome was documented follow-up of results within 3 days. Secondary outcomes included physician awareness and assessment of result urgency, impact on clinical assessments and plans, and preferred alerting scenarios.

KEY RESULTS

We evaluated the follow-up of 157 post-discharge microbiology results from patients of 121 physicians. We found documented follow-up in 27/97 (28%) results in the intervention group and 8/60 (13%) in the control group [aOR 3.2, (95% CI 1.3-8.4); p = 0.01]. Of all inpatient physician respondents, 32/82 (39%) were previously aware of the results, 45/77 (58%) felt the results changed their assessments and plans, 43/77 (56%) felt the results required urgent action, and 67/70 (96%) preferred alerts for current or broader scenarios.

CONCLUSION

Our alerting system improved the proportion of important post-discharge microbiology results with documented follow-up, though the proportion remained low. The alerts were well received and may be expanded in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1.
Figure 2.
Figure 3.

Similar content being viewed by others

References

  1. Roy CL, Poon EG, Karson AS, et al. Patient safety concerns arising from test results that return after hospital discharge. Ann Intern Med. 2005;143:121–8.

    PubMed  Google Scholar 

  2. Were MC, Li X, Kesterson J, et al. Adequacy of hospital discharge summaries in documenting tests with pending results and outpatient follow-up providers. J Gen Intern Med. 2009;24:1002–6.

    Article  PubMed  Google Scholar 

  3. El-Kareh R, Roy CL, Brodsky G, Perencevich M, Poon EG. Incidence and predictors of microbiology results returning post-discharge and requiring follow-up. J Hosp Med 2011.

  4. Wilson JW, Marshall WF, Estes LL. Detecting delayed microbiology results after hospital discharge: improving patient safety through an automated medical informatics tool. Mayo Clin Proc. 2011;86:1181–5.

    Article  PubMed  Google Scholar 

  5. Gandhi TK, Kachalia A, Thomas EJ, et al. Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann Intern Med. 2006;145:488–96.

    PubMed  Google Scholar 

  6. Kachalia A, Gandhi TK, Puopolo AL, et al. Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers. Ann Emerg Med. 2007;49:196–205.

    Article  PubMed  Google Scholar 

  7. Kuo YF, Sharma G, Freeman JL, Goodwin JS. Growth in the care of older patients by hospitalists in the United States. N Engl J Med. 2009;360:1102–12.

    Article  PubMed  CAS  Google Scholar 

  8. Wachter RM, Goldman L. The hospitalist movement 5 years later. JAMA. 2002;287:487–94.

    Article  PubMed  Google Scholar 

  9. Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007;297:831–41.

    Article  PubMed  CAS  Google Scholar 

  10. van Walraven C, Seth R, Laupacis A. Dissemination of discharge summaries. Not reaching follow-up physicians. Can Fam Physician. 2002;48:737–42.

    PubMed  Google Scholar 

  11. Walz SE, Smith M, Cox E, Sattin J, Kind AJ. Pending laboratory tests and the hospital discharge summary in patients discharged to sub-acute care. J Gen Intern Med 2010.

  12. Dalal AK, Poon EG, Karson AS, Gandhi TK, Roy CL. Lessons learned from implementation of a computerized application for pending tests at hospital discharge. J Hosp Med. 2011;6:16–21.

    Article  PubMed  Google Scholar 

  13. Poon EG, Gandhi TK, Sequist TD, Murff HJ, Karson AS, Bates DW. “I wish I had seen this test result earlier!”: Dissatisfaction with test result management systems in primary care. Arch Intern Med. 2004;164:2223–8.

    Article  PubMed  Google Scholar 

  14. Singh H, Wilson L, Reis B, Sawhney MK, Espadas D, Sittig DF. Ten strategies to improve management of abnormal test result alerts in the electronic health record. J Patient Saf. 2010;6:121–3.

    Article  PubMed  Google Scholar 

  15. Singh H, Wilson L, Petersen LA, et al. Improving follow-up of abnormal cancer screens using electronic health records: trust but verify test result communication. BMC Med Inform Decis Mak. 2009;9:49.

    Article  PubMed  Google Scholar 

  16. Poon EG, Wang SJ, Gandhi TK, Bates DW, Kuperman GJ. Design and implementation of a comprehensive outpatient Results Manager. J Biomed Inform. 2003;36:80–91.

    Article  PubMed  Google Scholar 

  17. Ferris TG, Johnson SA, Co JP, et al. Electronic results management in pediatric ambulatory care: qualitative assessment. Pediatrics. 2009;123(Suppl 2):S85–91.

    Article  PubMed  Google Scholar 

  18. Wahls TL, Cram PM. The frequency of missed test results and associated treatment delays in a highly computerized health system. BMC Fam Pract. 2007;8:32.

    Article  PubMed  Google Scholar 

  19. Graumlich JF, Novotny NL, Stephen Nace G, et al. Patient readmissions, emergency visits, and adverse events after software-assisted discharge from hospital: cluster randomized trial. J Hosp Med. 2009;4:E11–9.

    Article  PubMed  Google Scholar 

  20. Bates DW, Kuperman GJ, Wang S, et al. Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality. J Am Med Inform Assoc. 2003;10:523–30.

    Article  PubMed  Google Scholar 

  21. Campbell MK, Mollison J, Steen N, Grimshaw JM, Eccles M. Analysis of cluster randomized trials in primary care: a practical approach. Fam Pract. 2000;17:192–6.

    Article  PubMed  CAS  Google Scholar 

  22. Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27.

    Article  PubMed  CAS  Google Scholar 

  23. Jha AK, DesRoches CM, Campbell EG, et al. Use of electronic health records in US hospitals. N Engl J Med. 2009;360:1628–38.

    Article  PubMed  CAS  Google Scholar 

  24. Wang SJ, Kuperman GJ, Ohno-Machado L, Onderdonk A, Sandige H, Bates DW. Using electronic data to predict the probability of true bacteremia from positive blood cultures. Proc AMIA Symp 2000; 893–7.

Download references

Acknowledgements

This study was supported by grants from CRICO/RMF, Cambridge, MA, and the National Library of Medicine (2T15 LM 007092-17). The funding agencies played no role in the conduct of the study, collection, management, analysis, and interpretation of the data, or the preparation, review, or approval of the manuscript. Dr. El-Kareh had full access to all the data in the study and takes responsibility for the integrity and the accuracy of the data analysis.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Division of Biomedical Informatics, University of California San Diego, 9500 Gilman Dr., no. 0505, La Jolla, San Diego, CA, 92093-0505, USA

    Robert El-Kareh MD, MPH, MS

  2. Division of Hospital Medicine, University of California San Diego, 9500 Gilman Dr., no. 0505, La Jolla, San Diego, CA, 92093-0505, USA

    Robert El-Kareh MD, MPH, MS

  3. Division of General Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Christopher Roy MD, Deborah H. Williams MHA & Eric G. Poon MD, MPH

  4. Hospitalist Service, Brigham and Women’s Hospital, Boston, MA, USA

    Christopher Roy MD

  5. Information Systems, Partners Healthcare, Wellesley, MA, USA

    Eric G. Poon MD, MPH

  6. Harvard Medical School, Boston, MA, USA

    Christopher Roy MD & Eric G. Poon MD, MPH

Authors
  1. Robert El-Kareh MD, MPH, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher Roy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Deborah H. Williams MHA
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eric G. Poon MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert El-Kareh MD, MPH, MS.

Additional information

This study was funded by grants from CRICO/RMF and the National Library of Medicine (2T15 LM 07092-17), and was presented at the 34th Annual Meeting of the Society of General Internal Medicine on May 5, 2011 in Phoenix, AZ.

Rights and permissions

Reprints and permissions

About this article

Cite this article

El-Kareh, R., Roy, C., Williams, D.H. et al. Impact of Automated Alerts on Follow-Up of Post-Discharge Microbiology Results: A Cluster Randomized Controlled Trial. J GEN INTERN MED 27, 1243–1250 (2012). https://doi.org/10.1007/s11606-012-1986-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-012-1986-8

KEY WORDS

Search

Navigation