Notification of abnormal lab test results in an electronic medical record: do any safety concerns remain?
Singh H, Thomas EJ, Sittig DF, et al. Am J Med. 2010;123:238-244.
test result management systems
are a common problem in
, and failure (or inability) to promptly follow up abnormal test results may lead to
and other safety problems. Automated alerts within electronic health records should minimize such problems. However, this study conducted in Veterans Affairs clinics found that 1 in 10 alerts for abnormal laboratory test results went unread by providers, and a large proportion of those patients did not receive timely clinical follow-up. The investigators found similar results when analyzing follow-up of alerts for
abnormal imaging results
" is one possible explanation for these findings.
Unintended errors with EHR-based result management: a case series.
Yackel TR, Embi PJ. J Am Med Inform Assoc. 2010;17:104-107.
The management of test results in primary care: does an electronic medical record make a difference?
Elder NC, McEwen TR, Flach J, Gallimore J, Pallerla H. Fam Med. 2010;42:327-333.
Electronic health record-based surveillance of diagnostic errors in primary care.
Singh H, Giardina TD, Forjuoh SN, et al. BMJ Qual Saf. 2012;22:93-100.
Lost surgical specimens, lost opportunities.
PA-PSRS Patient Saf Advis. September 2005;2:1-5.
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Setting of Care
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Pathology & Laboratory Medicine
Missed or Critical Lab Results
Approach to Improving Safety
Laboratory Result Tracking Improvement
Computerized Adverse Event Detection
Electronic Health Records
Department of Veterans Affairs (VA)
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