Even test results sent to clinicians electronically can be missed, often owing to socio-technical factors.BMJ Open. 2014;4:e005985.
How context affects electronic health record–based test result follow-up: a mixed-methods evaluation.
Menon S, Smith MW, Sittig DF, et al. BMJ Open. 2014;4:e005985.
Failure to follow up on test results is a common source of missed or delayed diagnoses, especially in the outpatient setting. Even in systems with highly-integrated electronic health records, such as the Veterans Affairs health system, problems with test follow-up persist. This study explored various sociotechnical factorsthat may contribute to missed test results. Although the vast majority of facilities required that unread alerts remain in the ordering providers' inbox for at least 14 days, only about 70% of facilities had some mechanism to prevent alerts from remaining unread. Interviews with patient safety managers and information technologists revealed a number of generalizable high-risk scenarios. Tests ordered by trainees frequently led to issues with follow-up since trainees often rotated to other sites and rarely followed full protocols to ensure test follow-up. Even when a surrogate was assigned to receive alerts during a clinician's absence, there were many problems with lack of clear responsibilities and communication. A previous AHRQ WebM&M commentary discussed the many issues that contribute to missed test follow-up.
Electronic medical records may boost patient safety.
Cornish A. National Public Radio. July 15, 2013.
Medication discrepancies in integrated electronic health records.
Linsky A, Simon SR. BMJ Qual Saf. 2013;22:103-109.
The role of the electronic health record in patient safety events.
Sparnon E, Marella WM. PA-PSRS Patient Saf Advis. 2012;9:113-121.
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Matching identifiers in electronic health records: implications for duplicate records and patient safety.
McCoy AB, Wright A, Kahn MG, Shapiro JS, Bernstam EV, Sittig DF. BMJ Qual Saf. 2013;22:219-224.