Almost 38% of patients sent home from the hospital had at least one incomplete laboratory test or a test result that had not been reviewed before discharge, reported a study in the September 24 issue of the Archives of Internal Medicine. Moreover, about 14% of results left unchecked were outside the reference range.
Enrico Coiera, PhD of the University of New South Wales and colleagues conducted the study at a 370-bed teaching hospital in Sydney, Australia, and reviewed close to 700,000 laboratory tests performed on more than 6,700 inpatients between February and July 2011. They found that 3.1% of these tests were not reviewed upon discharge, and about half of those (1.5% of total) was still unchecked two months later. The study did not address whether a doctor's lack of awareness of abnormal test results affected patient care or how well the patients fared after going home.
The time-frame in which tests are ordered impacts the likelihood that the tests will be completed and results reviewed before a patient goes home, noted the researchers. Tests ordered earlier during a hospital stay are more likely to be evaluated, while those requested the same day that a patient is discharged may be overlooked until well after release from the hospital. However, some tests take longer to perform and, even if ordered earlier, may not be completed by the time a patient goes home. Regardless, follow-up is important on all laboratory work and can reduce medical errors.
"Failure to follow up test results contributes to patient harm, affecting between 20% and 61% of inpatient tests,” write the researchers. "Such missed results are clinically significant, with the potential to affect patient care."
In an editor's note in the same journal issue, Deborah Grady, MD, MPH commented, "Because patients are judged ready to go home on the day of discharge, most tests ordered that day are unlikely to change care and are probably not needed. However, if an important test result is required to guide care at discharge, providers need to figure out a process to ensure follow up."
While it may not be realistic to expect all tests to be complete before going home, timely reporting and review of tests even after discharge may be key to a patient's care at home. Patients and their caregivers cannot assume that all is good if they do not hear back about tests, even those done the last day of the stay. During a last consultation with the doctor about medicine or other instructions as part of discharge planning, it may be a good idea to ask about any pending test results. Once home, a follow-up visit or phone call to ask questions about any final test reports may be advisable as well.
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(September 24, 2012) Coiera E, et al. Last Orders: Follow up of Tests Ordered on the Day of Discharge. Archives of Internal Medicine. Available online at http://archinte.jamanetwork.com/article.aspx?articleid=1309574 through http://archinte.jamanetwork.com. Accessed October 2, 2012.
(September 24, 2012) Grady D. Let's Just Check That Potassium One More Time…Editor's Note. Archives of Internal Medicine. Available online at http://archinte.jamanetwork.com/article.aspx?articleid=1309580 throughhttp://archinte.jamanetwork.com. Accessed October 2. 2012.
(August 13, 2012) Genevra Pittman. Hospital patients often sent home with pending tests. Reuters Health. Available online at http://www.reuters.com/article/2012/08/13/us-patients-tests-idUSBRE87C0Z120120813 through http://www.reuters.com. Accessed October 2, 2012.
(September 17, 2012) Nicole Ostrow. Lab tests not always checked before patients go home. Daily Herald. Available online at http://www.dailyherald.com/article/20120917/entlife/709179985/ through http://www.dailyherald.com. Accessed October 2, 2012.