Notification of Abnormal Lab Test Results in an Electronic Medical Record: Do Any Safety Concerns Remain?

被引：118

作者：

Singh, Hardeep ^{[1
,2
]}

Thomas, Eric J. ^{[3
]}

Sittig, Dean F. ^{[4
,5
]}

Wilson, Lindsey ^{[1
,2
]}

Espadas, Donna ^{[1
,2
]}

Khan, Myrna M. ^{[1
,2
]}

Petersen, Laura A. ^{[1
,2
]}

机构：

[1] Baylor Coll Med, Houston VA Hlth Serv Res & Dev Ctr Excellence, Ctr Inquiry Improve Outpatient Safety Effect Elec, Michael E DeBakey Vet Affairs Med Ctr, Houston, TX 77030 USA

[2] Baylor Coll Med, Sect Hlth Serv Res, Dept Med, Houston, TX 77030 USA

[3] Univ Texas Houston, Div Gen Med, Dept Med,Univ Texas Med Sch Houston, Mem Hermann Ctr Healthcare Qual & Safety, Houston, TX USA

[4] Univ Texas Sch Hlth Informat Sci, Houston, TX USA

[5] UT Mem Hermann Ctr Healthcare Qual & Safety, Houston, TX USA

来源：

AMERICAN JOURNAL OF MEDICINE | 2010年 / 123卷 / 03期

关键词：

Abnormal diagnostic test results; Communication; Diagnostic errors; Electronic medical records; Health information technology; Patient follow-up; Patient safety; Primary care; FOLLOW-UP; DIAGNOSTIC ERRORS; COMMUNICATION; TECHNOLOGY;

D O I：

10.1016/j.amjmed.2009.07.027

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND: Follow-up of abnormal outpatient laboratory test results is a major patient safety concern. Electronic medical records can potentially address this concern through automated notification. We examined whether automated notifications of abnormal laboratory results (alerts) in an integrated electronic medical record resulted in timely follow-up actions. METHODS: We studied 4 alerts: hemoglobin Alc >= 15%, positive hepatitis C antibody, prostate-specific antigen >= 15 ng/mL and thyroid-stimulating hormone >= 15 mlU/L. An alert tracking system determined whether the alert was acknowledged (ie, provider clicked on and opened the message) within 2 weeks of transmission;. acknowledged alerts were considered read. Within 30 days of result transmission, record review and provider contact determined follow-up actions (eg. patient contact, treatment). Multivariable logistic regression models analyzed predictors for lack of timely follow-up. RESULTS: Between May and December 2008, 78,158 tests (hemoglobin Ale, hepatitis C antibody, thyroid- stimulating hormone, and prostate-specific antigen) were performed, of which 1163 (1.48%) were transmitted as alerts; 10.2% of these (119/1163) were unacknowledged. Timely follow-up was lacking in 79 (6.8%), and was statistically not different for acknowledged and unacknowledged alerts (6.4% vs 10.1 %; P = .13). Of 1163 alerts, 202 (17.4%) arose from unnecessarily ordered (redundant) tests. Alerts for a new versus known diagnosis were more likely to lack timely follow-up (odds ratio 7.35; 95% confidence interval, 4.16-12.97), whereas alerts related to redundant tests were less likely to lack timely follow-up (odds ratio 0.24; 95% confidence interval, 0.07-0.84). CONCLUSIONS: Safety concerns related to timely patient follow-up remain despite automated notification of non-life-threatening abnormal laboratory results in the outpatient setting, Published by, Elsevier Inc. . The American Journal of Medicine (2010) 123, 238-244

引用

页码：238 / 244

页数：7

共 26 条

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