Some doctors keep patients in the dark

CORNELL (US)—A new analysis shows that physicians failed to report clinically significant abnormal test results to patients—or to document that they had informed them—in one out of every 14 cases of abnormal results.

“We found that very few physician practices had explicit rules for managing test results,” says study leader Lawrence P. Casalino, associate professor of public health at Weill Cornell Medical College. “In many practices, each physician devised his or her own method. And in many cases, physicians and their staff told patients that ‘no news is good news’—meaning they should assume that their tests are normal unless they are contacted. This is a dangerous assumption.”

The analysis of 5,434 patient records from 23 physician practices was published in the Archives of Internal Medicine. The findings revealed wide disparities, with some medical groups having a failure rate close to zero, while others with abnormal result rates as high as one in four.

Casalino and his coinvestigators revealed that groups using simple processes to manage test results had lower failures rates. Groups that did not consistently use these processes had both higher failure rates and physicians who were dissatisfied with their group’s processes for managing test results. The study also found that having an electronic medical record did not reduce failure-to-inform rates—and even increased them—if the practice did not have good processes in place for managing test results.

“Failure to report abnormal test results can lead to serious, even lethal consequences for the patient,” says Casalino. “The good news is that physicians who use a simple set of systematic processes to deal with test results can greatly lessen their error rates.”

The study suggests that five simple, common-sense processes are useful for dealing with test results: (1) all test results are routed to the responsible physician; (2) the physician signs off on all results; (3) the practice informs patients of all results, normal and abnormal, at least in general terms; (4) the practice documents that the patient has been informed; and (5) patients are told to call after a certain time interval if they have not been notified.

“With the recent enactment of federal stimulus legislation to support greater adoption of health information technology, this study demonstrates why health IT hardware alone will not improve care,” says Mark Smith, president and CEO of the California HealthCare Foundation, which funded the research. “Ensuring that processes are in place to efficiently notify patients of their lab results should be part of the meaningful use of electronic health records.”

Researchers from Northwestern University, University of Chicago, Mount Sinai School of Medicine, University of California at Los Angeles, and Rush University Medical Center in Chicago contributed to the study.

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