Article Text

The safety implications of missed test results for hospitalised patients: a systematic review
  1. Joanne Callen,
  2. Andrew Georgiou,
  3. Julie Li,
  4. Johanna I Westbrook
  1. Centre for Health Systems and Safety Research, The University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Dr Joanne Callen, Centre for Health Systems and Safety Research, The University of New South Wales, Sydney NSW 2052, Australia; j.callen{at}unsw.edu.au

Abstract

Background Failure to follow-up test results is a critical safety issue. The objective was to systematically review evidence quantifying the extent of failure to follow-up test results and the impact on patient outcomes.

Methods The authors searched Medline, CINAHL, Embase, Inspec and the Cochrane Database from 1990 to March 2010 for English-language articles which quantified the proportion of diagnostic tests not followed up for hospital patients. Four reviewers independently reviewed titles, abstracts and articles for inclusion.

Results Twelve studies met the inclusion criteria and demonstrated a wide variation in the extent of the problem and the impact on patient outcomes. A lack of follow-up of test results for inpatients ranged from 20.04% to 61.6% and for patients treated in the emergency department ranged from 1.0% to 75% when calculated as a proportion of tests. Two areas where problems were particularly evident were: critical test results and results for patients moving across healthcare settings. Systems used to manage follow-up of test results were varied and included paper-based, electronic and hybrid paper-and-electronic systems. Evidence of the effectiveness of electronic test management systems was limited.

Conclusions Failure to follow up test results for hospital patients is a substantial problem. Evidence of the negative impacts for patients when important results are not actioned, matched with advances in the functionality of clinical information systems, presents a convincing case for the need to explore solutions. These should include interventions such as on-line endorsement of results.

  • Diagnostic tests, routine
  • medical errors
  • CPOE
  • assessment, patient outcomes
  • continuity of patient care
  • review
  • systematic
  • healthcare quality
  • medical error
  • patient outcomes

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Supplementary materials

Footnotes

  • Funding This study is part of an Australian Research Council Linkage Grant (LP0989144) funded project to investigate the use of information and communication technologies to support effective work practice innovation in the health sector.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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