Improving Follow-Up of Tests Pending at Discharge

Author:

Shriner Andrew R.12,Baker Richelle M.12,Ellis Andrew34,Dixon Rebecca12,Saysana Michele12

Affiliation:

1. Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana

2. Department of Pediatrics, Section of Hospital Medicine School of Medicine, Indiana University, Indianapolis, Indiana

3. Mercy Children’s Hospital, St Louis, Missouri

4. Department of Child Health School of Medicine, University of Missouri, Columbia, Missouri

Abstract

BACKGROUND AND OBJECTIVES Follow-up on results of inpatient tests pending at discharge (TPAD) must occur to ensure patient safety and high-quality care continue after discharge. We identified a need to improve follow-up of TPAD and began a quality improvement initiative with an aim of reducing the rate of missed follow-up of TPAD to ≤20% within 12 months. METHODS The team used the Plan-Do-Study-Act method of quality improvement and implemented a process using reminder messages in the electronic health record. We collected data via retrospective chart review for the 6 months before the intervention and monthly thereafter. The primary outcome measure was the percentage of patients with missed follow-up of TPAD, defined as no documented follow-up within 72 hours of a result being available. The use of a reminder message was monitored as a process measure. RESULTS We reviewed charts of 764 discharged patients, and 216 (28%) were noted to have TPAD. At baseline, the average percentage of patients with missed follow-up was 80%. The use of reminder messages was quickly adopted. The average percentage of patients with missed follow-up of TPAD after beginning the quality improvement interventions was 35%. CONCLUSIONS We had significant improvement in follow-up after our interventions. Additional work is needed to ensure continued and sustained improvement, focused on reducing variability in performance between providers and investing in technology to allow for automation of the follow-up process.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics,General Medicine,Pediatrics, Perinatology, and Child Health

Reference21 articles.

1. The frequency of missed test results and associated treatment delays in a highly computerized health system;Wahls;BMC Fam Pract,2007

2. Medical errors related to discontinuity of care from an inpatient to an outpatient setting;Moore;J Gen Intern Med,2003

3. The safety implications of missed test results for hospitalised patients: a systematic review;Callen;BMJ Qual Saf,2011

4. Joint Commission. National patient safety goals effective January 2021 for the hospital program. Available at: https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2021/npsg_chapter_hap_jan2021.pdf. Accessed October 20, 2021

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