Do physicians followup on lab test results?
A recent study published in the Archives of Internal Medicine investigated how often physicians review the results of laboratory test results that were ordered on the day of discharge from the hospital. The investigators reviewed 662, 858 clinical laboratory tests that were ordered during 6736 inpatient admissions at a 370 bed teaching hospital. More than one third (38%) of these admissions had at least 1 test not reviewed before discharge and 28% of admissions still had test results that had not reviewed by 2 months after discharge.
Overall, 3.1% of tests ordered during admission were not reviewed at discharge and 1.5% had still not been reviewed by 2 months after discharge. Of these un-reviewed results, 15% were abnormal. Two thirds of the un-reviewed abnormal results had been ordered on the day of discharge.
Altogether, this study suggests that tests ordered on day of discharge, even if they were abnormal, were unlikely to be acted upon and were unlikely to change a physician’s care plan. Therefore, tests ordered on the last day of hospitalization, when a patient has been deemed healthy enough to go home are probably not needed and should not be ordered.
Arch Intern Med, Aug 13, 2012. Doi:10.1001/archinternmed.2012.2836).
Another literature review found only 12 studies that quantified follow-up of lab & radiology results on hospitalized patients. The failure to follow-up ranged from 20 to 69% for inpatients and 1 to 75% for emergency room patients. Microbiology test results were most likely not to be followed, ranging from 3 to 75%. Interestingly, having an electronic health record (EHR) did not seem to improve performance. (BMJ Qual Safe 2011;20:194-199)
