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Journal Article > Study
The effect of a clinical decision support for pending laboratory results at emergency department discharge.
Driver BE, Scharber SK, Fagerstrom ET, Klein LR, Cole JB, Dhaliwal RS. J Emerg Med. 2019;56:109-113.
This pre–post study examined the effect of an electronic health record alert that required physicians to respond "yes" or "no" regarding whether tests were pending at the time of discharge from the emergency department. Investigators found that physician responses were often inaccurate, and the proportion of discharged patients with tests pending increased following the intervention, contrary to intentions.
Cases & Commentaries
- Web M&M
Robert E. O'Connor, MD, MPH; March 2018
Emergency medical service (EMS) providers obtained an electrocardiogram (ECG) in a woman who had developed severe chest pressure at home. The ECG revealed an ST-elevation myocardial infarction (STEMI). Unfortunately, the ECG failed to transmit to the emergency department (ED) while EMS was en route, so a "Code STEMI" was not activated. Unaware of the original ECG results, ED clinicians obtained a repeat ECG that did not demonstrate the earlier ST segment elevations, and the patient was admitted to the telemetry unit for monitoring overnight. The next morning, lab results revealed an elevated troponin level and another ECG demonstrated she had a large heart attack the previous day. Although the patient was rushed to the cardiac catheterization laboratory, the delay in treatment led to significant loss of cardiac function.
Journal Article > Study
Emergency physicians' views of direct notification of laboratory and radiology results to patients using the internet: a multisite survey.
Callen J, Giardina TD, Singh H, et al. J Med Internet Res. 2015;17:e60.
Providing test results directly to patients is one way in which enhanced patient engagement could improve safety, as failure to appropriately follow up on test results is a recognized cause of diagnostic errors. Accomplishing this will require endorsement from physicians, and this survey examines the attitudes of Australian emergency physicians regarding direct provision of test results to patients. The majority of physicians expressed discomfort with patients having direct access to test results, mainly because physicians feared patients would experience undue anxiety or lack the knowledge necessary to interpret the results. More physicians supported providing patients with direct access to normal test results than abnormal test results, mirroring the findings of a prior survey of primary care providers. Physicians were more supportive of direct release of test results if it would decrease their own workload. The results of this survey reveal the need for careful exploration of the best methods to increase patient engagement without disregarding clinicians' concerns. A previous AHRQ WebM&M interview with Dave deBronkart discussed allowing patients to access their medical records.
Washington, DC: Department of Veterans Affairs, Office of Inspector General; October 23, 2013. Report No. 13-00505-348.