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Timely Follow-Up of Abnormal Outpatient Test Results: Perceived Barriers and Impact on Patient Safety

Moore, Carlton MD, MS*; Saigh, Orit MD; Trikha, Anita MD; Lin, Jenny J. MD§

doi: 10.1097/PTS.0b013e31818d1ca4
Original Articles

Purpose: To assess internal medicine physicians' perceptions regarding delays in the follow up of ambulatory test results and the clinical consequences of delays.

Methods: Anonymous survey of internal medicine physicians at 3 large academic medical centers. The survey asked about physician practices regarding follow up of commonly ordered ambulatory test results, major barriers to follow-up, and perception of harm due to delayed follow-up.

Results: One hundred ninety-five (66%) of 297 eligible physicians completed the survey. House staff physicians were more likely to take 1 or more weeks to review the results of tests sent on their ambulatory patients. Forty-six percent of house staff physicians took 1 or more weeks to review laboratory results compared with only 8% of attending physicians (P < 0.001), and 58.7% of house staff physicians took 1 or more weeks to review radiographic study results compared with 24.5% of attending physicians (P < 0.001). The most common barrier to timely follow up was the lack of a reminder system. Overall, at least a few times per year, 70.4% of respondents reported seeing patients with delays in diagnosis or treatment because of delays in test result follow-up, and 40.4% reported seeing patients with worsening medical conditions because of delays in follow-up.

Conclusions: Physicians perceive that the lack of timely follow up of abnormal test results is common in the ambulatory setting and that patients are harmed as a result. Interventions such as automatic reminders and changes in house staff workflow are needed to ensure that abnormal test results are followed up in a timely manner.

From the *Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; †Department of Medicine, Beth Israel Medical Center, New York, New York; ‡Division of General Internal Medicine, San Diego Veterans Administration Medical Center, San Diego, California; and §Division of General Internal Medicine, Mount Sinai School of Medicine, New York, New York.

Correspondence: Carlton Moore, MD, MS, Division of General Medical and Clinical Epidemiology, University of North Carolina at Chapel Hill, 5039 Old Clinic Bldg, CB 7110 Chapel Hill, NC 27599-7110 (e-mail: carlton_moore@med.unc.edu).

© 2008 Lippincott Williams & Wilkins, Inc.