Improving Management of Test Results that Return After Hospital Discharge

Many patients discharged from a hospital with pending test results experience medical errors. These errors occur because pending tests are often not communicated to the followup provider, and systems to manage results are generally suboptimal. Discharge summaries – the primary mode of inpatient-to-outpatient communication – infrequently mention pending tests, and those that do contain inaccuracies and inadequacies. Outpatient providers report being unaware of up to 60 percent of results that require a change in patient management, and are dissatisfied with existing systems to follow results. While the problems related to poor management of test results returning after hospital discharge are widely acknowledged, little has been done to implement and evaluate interventions to improve existing systems.

This project developed, implemented, and evaluated the impact of a computerized tool to automatically identify tests with pending results at hospital discharge, and assist in communicating those to followup providers through the hospital discharge summary. A copy of the pending tests can be printed and given to patients for outpatient appointments. In addition, this project created a modification to an existing clinical messaging tool so that results of pending tests were automatically delivered to followup providers.

The specific aims of this project were to:

• Develop and implement a computerized tool to automatically identify tests with pending results at hospital discharge and assist in the incorporation of these tests into the discharge summary. 
• Evaluate the impact of this tool on accuracy of documenting pending tests in discharge summaries. 
• Modify an existing clinical-messaging program to enable automatic delivery of returning results for pending tests to the designated outpatient followup providers. 
• Evaluate how the automatic delivery of test results impacts followup providers' actions and attitudes. 

The tool was evaluated with a before-and-after time series study. Providers were surveyed on how to identify the responsible provider to manage pending tests. Chart reviewers rated each test result on whether it required a change in patient management and determined if and when appropriate actions were taken in response to each result. Inpatient and outpatient providers were surveyed to assess their attitudes toward their systems for managing test results returning after hospital discharge, and their specific attitudes toward automatic delivery of results.

The project team found that providers did not agree on the responsible provider for pending inpatient tests, and indicated a need for a consensus policy to be developed on this issue. There was a statistically significant increase in documentation of pending tests following implementation of the tool. Surveys indicated that inpatient providers believe that the “tests with pending results” field on the discharge summary impacts the quality of patient care, improves the quality of documenting tests with pending results into discharge summaries, and believe this field should be a permanent part of the discharge summary. Providers who received the results following hospital discharge generally felt that the delivery of the results improved quality of care, decreased errors in care, reduced time searching for results, and that the automatic delivery of results returning after hospital discharge should continue.