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Search results for "Information Professionals"

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Journal Article > Study

Electronic detection of delayed test result follow-up in patients with hypothyroidism.

Meyer AND, Murphy DR, Al-Mutairi A, et al. J Gen Intern Med. 2017;32:753-759.

Trigger tools facilitate identification of adverse events. In this retrospective medical record review study, investigators found that an automated trigger successfully identified delayed follow-up of laboratory thyroid testing among patients with hypothyroidism, with a positive predictive value of 60%. The authors suggest that this trigger approach could be used to detect and ameliorate follow-up delays in real time.

Journal Article > Study

Improving patient safety: avoiding unread imaging exams in the National VA enterprise electronic health record.

Bastawrous S, Carney B. J Digit Imaging. 2017;30:309-313.

Inadequate test result management is known to contribute to missed and delayed diagnosis. This Veterans Affairs study found that 0.17% of radiologic studies were not evaluated by radiologists. The study team identified several technical and process problems that contributed to these unread studies. They were able to address the issues to ensure all studies were read.

Journal Article > Study

Significant reduction in preanalytical errors for nonphlebotomy blood draws after implementation of a novel integrated specimen collection module.

Le RD, Melanson SE, Petrides AK, et al. Am J Clin Pathol. 2016;146:456-461.

Laboratory errors, such as mislabeling, improper collection, or specimen loss, can lead to delays in diagnosis and the need for repeat procedures or blood draws. In this single institution study, implementing a custom-built specimen collection module led to a significant decrease in the rate of lab specimen collection and handling errors for blood samples drawn by nurses in both the emergency department and inpatient settings.

Journal Article > Study

Computerized triggers of big data to detect delays in follow-up of chest imaging results.

Murphy DR, Meyer AND, Bhise V, et al. Chest. 2016;150:613-620.

Insufficient follow-up of test results is a known contributor to missed and delayed diagnosis. This observational study used a trigger tool to detect diagnostic delays related to chest imaging follow-up. Investigators used an automated algorithm to identify chest imaging cases that potentially had a follow-up delay. A clinician then reviewed the medical records for a random sample of cases identified by the trigger tool and a reference set of cases involving patients with abnormal test results but no delays. They found that the trigger tool had 99% sensitivity and 38% specificity in detecting delays in follow-up of abnormal chest imaging. The authors suggest that this trigger tool may help identify patients at risk for diagnostic delay following abnormal chest imaging. A WebM&M commentary discussed delayed follow-up of a diagnostic test.

Journal Article > Study

Development and validation of electronic health record–based triggers to detect delays in follow-up of abnormal lung imaging findings.

Murphy DR, Thomas EJ, Meyer AND, Singh H. Radiology. 2015;277:81-87.

Delays in follow-up of abnormal test results are known to contribute to delayed and missed diagnosis. Investigators developed and validated an electronic trigger to identify potential delays in follow-up of abnormal chest computed tomography scans. This study found that more than half of the flagged cases had a true diagnostic delay. This work should lead to prospective evaluation of trigger approaches to enhance test result follow-up.

Journal Article > Study

Laboratory medicine handoff gaps experienced by primary care practices: a report from the Shared Networks of Collaborative Ambulatory Practices and Partners (SNOCAP).

West DR, James KA, Fernald DH, Zelie C, Smith ML, Raab SS. J Am Board Fam Med. 2014;27:796-803.

This survey-based study of primary care providers revealed a lack of standardization for the tracking, receiving, and reporting of laboratory results. Even practices with integrated electronic medical records reported the need for a back-up tracking system to ensure important test results are not lost.

Journal Article > Study

Are amended surgical pathology reports getting to the correct responsible care provider?

Parkash V, Domfeh A, Cohen P, et al. Am J Clin Pathol. 2014;142:58-63.

In this chart review study, amended pathology reports with clinically significant patient results did not reliably reach treating clinicians. Despite prior studies highlighting the shortcomings of test results reporting, this patient safety issue persists.

Journal Article > Study

Syndromic surveillance for health information system failures: a feasibility study.

Ong MS, Magrabi F, Coiera E. J Am Med Inform Assoc. 2013;20:506-512.

Syndromic surveillance—an approach used to identify infectious disease epidemics—can be applied to monitor health information technologies for early signs of unreliability or failure.

Journal Article > Study

Decoding laboratory test names: a major challenge to appropriate patient care.

Passiment E, Meisel JL, Fontanesi J, Fritsma G, Aleryani S, Marques M. J Gen Intern Med. 2013;28:453-458.

This commentary identifies the lack of standardized abbreviations for common laboratory tests as a potential patient safety threat, as clinicians may inadvertently order incorrect or duplicative tests. A prior study found a significant incidence of incorrect test ordering, despite use of a computerized provider order entry system.

Journal Article > Study

Design and implementation of an automated email notification system for results of tests pending at discharge.

Dalal AK, Schnipper JL, Poon EG, et al. J Am Med Inform Assoc. 2012;19:523-538.

Management of tests pending at discharge (TPAD) is a continued focus of safety efforts. Although improved discharge summaries address certain gaps in communication, additional strategies are still required. This study describes the development and implementation of an automated TPAD email notification system. The goal was to push results to the discharging inpatient provider and facilitate communication with primary care providers. Discharging providers received approximately 1.6 email notifications per discharged patient and were satisfied overall with the new system. The authors reflect on key elements of improving the system, which include further refinement of the computer logic to minimize alert fatigue and careful attention to assigning accountability for acting on the notifications. A past AHRQ WebM&M commentary discussed an adverse outcome that resulted from poor test follow-up after hospital discharge.

Journal Article > Commentary

Beyond the prescription: medication monitoring and adverse drug events in older adults.

Steinman MA, Handler SM, Gurwitz JH, Schiff GD, Covinsky KE. J Am Geriatr Soc. 2011;59:1513-1520.

This commentary suggests strategies for improving prescribing safety, including linking pharmacy and laboratory data through health information technology.

Journal Article > Review

The safety implications of missed test results for hospitalised patients: a systematic review.

  • Classic

Callen J, Georgiou A, Li J, Westbrook JI. BMJ Qual Saf 2011;20:194-199.

Adverse events after hospital discharge are a growing driver for safety interventions, including a focus on readmissions, adverse drug events, and hospital-acquired infections. Another safety area ripe for intervention is managing test results after hospital discharge. This systematic review analyzed 12 studies and found wide variation in rates of test follow-up and related management systems. Critical test results and results for patients moving across health care settings were highlighted as particularly concerning areas that could be addressed with better clinical information systems. A past AHRQ WebM&M commentary discussed a case where a patient was incorrectly treated based on failure to follow up a urine culture after hospital discharge.

Journal Article > Review

Impact of health information technology interventions to improve medication laboratory monitoring for ambulatory patients: a systematic review.

Fischer SH, Tjia J, Field TS. J Am Med Inform Assoc. 2010;17:631-636.

Failure to follow up on test results has been linked to missed and delayed diagnoses in the ambulatory setting. Although electronic health records (EHR) hold great promise for addressing this issue, this systematic review found only modest published evidence linking EHR use to improved laboratory test monitoring. This finding corroborates other studies documenting persistent failure to comprehensively follow up abnormal lab tests and radiologic studies despite use of an EHR. The authors conclude that further research will be required to develop optimal test management systems within electronic medical records.

Journal Article > Study

Notification of abnormal lab test results in an electronic medical record: do any safety concerns remain?

  • Classic

Singh H, Thomas EJ, Sittig DF, et al. Am J Med. 2010;123:238-244.

Unreliable test result management systems are a common problem in ambulatory care, and failure (or inability) to promptly follow up abnormal test results may lead to diagnostic errors 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. "Alert fatigue" is one possible explanation for these findings.

Journal Article > Commentary

Responding to large-scale testing errors.

Valenstein PN, Alpern GA, Keren DF. Am J Clin Pathol. 2010;133:440-446.

Using two case examples, this article analyzes the causes and consequences of laboratory testing errors. The authors also identify responsibilities after such instances occur.

Journal Article > Study

Improving follow-up of abnormal cancer screens using electronic health records: trust but verify test result communication.

Singh H, Wilson L, Petersen LA, et al. BMC Med Inform Decis Mak. 2009;9:49.

Technical problems with an electronic reminder system resulted in failure to follow up many abnormal fecal occult blood test results.

Cases & Commentaries

EMR Entry Error: Not So Benign

  • Web M&M

Ross Koppel, PhD; April 2009

A patient hospitalized with Pneumocystis jiroveci pneumonia and advanced AIDS is given another patient's malignant biopsy results, leading his primary physician to mistakenly recommend hospice care.

Journal Article > Review

Causes, consequences, detection, and prevention of identification errors in laboratory diagnostics.

Lippi G, Blanckaert N, Bonini P, et al. Clin Chem Lab Med. 2009;47:143-153.

This review provides an overview of identification errors in laboratory medicine, building on past efforts to highlight practical solutions for prevention.

Journal Article > Study

Impact of non-interruptive medication laboratory monitoring alerts in ambulatory care.

Lo HG, Matheny ME, Seger DL, Bates DW, Gandhi TK. J Am Med Inform Assoc. 2009;16:66-71.

"Alert fatigue" refers to the tendency of clinicians to ignore safety alerts—for example, warnings about potential drug interactions—if alerts are too frequent or perceived to be clinically irrelevant. However, in this study, less intrusive alerts that did not require physician response were not effective at encouraging use of recommended laboratory monitoring.

Journal Article > Study

A randomized trial of electronic clinical reminders to improve medication laboratory monitoring.

  • Classic

Matheny ME, Sequist TD, Seger AC, et al. J Am Med Inform Assoc. 2008;15:424-429.

Electronic reminders to clinicians are one of the earliest methods used to improve patient safety. In this cluster-randomized controlled trial conducted in primary care clinics, clinicians received targeted reminders within the existing electronic medical record prompting them to order laboratory tests to detect adverse medication effects. The most encouraging study result was that clinicians were generally already monitoring patients as recommended—in contrast to data from prior studies—and as a result, the reminders did not appreciably increase test ordering. Prior research has addressed barriers to effective implementation of electronic reminders.

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