Research Activities, December 2010: Safety and Quality of Care: Physicians can use 10 strategies to manage abnormal test result alerts in electronic health records

Safety and Quality of Care


Physicians can use 10 strategies to manage abnormal test result alerts in electronic health records

One of the biggest safety issues in physician offices and other outpatient settings is overlooking abnormal test results. Electronic health records (EHRs) can potentially reduce the risk of overlooking test results through use of notification systems that alert clinicians. Despite such interventions, about 7 to 8 percent of abnormal lab and imaging results are still not followed up within 30 days. What's more, clinicians may not acknowledge all of the alerts they receive. In an attempt to help clinicians, researchers have come up with 10 strategies to improve management of test result alerts. The strategies are based on results from a project funded by the Department of Veterans Affairs' National Center for Patient Safety.

Four of the strategies are clinician-centered and require additional training. First, clinicians should be encouraged to customize their nonmandatory notifications depending on their preferences. Second, they should be aware of the "renew alert" feature that lets them save alerts once acknowledged. Also helpful is for clinicians to use the "process all" or similar feature in EHRs. This enables them to process alerts one after another without having to go back constantly to the alert inbox/window. Finally, when short on time, clinicians should develop a strategy for prioritizing alerts based on an alert's urgency level.

Three strategies involve the human-computer interface. These include taking full advantage of the sorting feature to view higher priority alerts first or to process similar types of alerts at the same time. Notification window size can also be enlarged in order to see more alerts at once. The same is true for resizing the width of data columns in order to see all of the text in a string.

The last three strategies deal with communication and workflow. When away from the office, clinicians should use the "surrogate clinician" feature and temporarily customize the volume of alerts transmitted to the covering partner. Another valuable feature is the "alert when results." This allows an additional clinician to be notified when test results are available. The final strategy encourages clinicians to communicate verbally and clarify responsibility when multiple clinicians receive notification of the same test result. The study was supported in part by the Agency for Healthcare Research and Quality (HS17586).

See "Ten strategies to improve management of abnormal test result alerts in the electronic health record," by Hardeep Singh, M.D., M.P.H., Lindsey Wilson, M.A., Brian Reis, B.E., and others in the June 2010 Journal of Patient Safety 6(2), pp. 121-123.

Research Activities, December 2010: Safety and Quality of Care: Physicians can use 10 strategies to manage abnormal test result alerts in electronic health records