BACKGROUND: Missed or delayed follow-up of abnormal subcritical tests (tests that do not require immediate medical attention) can lead to poor patient outcomes. Safety-net health systems with limited resources and socially complex patients are vulnerable to safety gaps resulting from delayed management. Clinician perspectives to identify system challenges, vulnerable situations, and potential solutions were sought in focus groups. METHODS: Five semistructured focus groups were conducted in 2015 with purposefully sampled clinicians from radiology, hospital medicine, emergency medicine, risk management, and ambulatory care from an urban, academic, integrated, safety-net health system. Thematic analysis identified challenges of current management of abnormal subcritical tests, vulnerable situations, and solution characteristics. A total of 43 clinicians participated. RESULTS: Clinicians cited challenges in assigning responsibility for follow-up and identified tests pending at discharge and tests requiring delayed follow-up as vulnerable situations. The lack of tracking systems and missing contact information for patients and providers exacerbated these challenges. Proposed solution characteristics involved protocols to aid in assigning responsibility, reliable paths of communication, and systems to track the status of tests. Clinicians noted a strong desire for integration of the work flow and technology solutions into existing structures. CONCLUSION: In an urban safety-net setting, clinicians recommended outlining clear chains of responsibility and communication in the management of subcritical test results, and employing simple, integrated technological solutions that allow for tracking and management of tests. Existing test management solutions should be adapted to work within safety-net systems, which often have fewer resources and more complex patients and may function in the absence of integrated technology systems.
BACKGROUND: Missed or delayed follow-up of abnormal subcritical tests (tests that do not require immediate medical attention) can lead to poor patient outcomes. Safety-net health systems with limited resources and socially complex patients are vulnerable to safety gaps resulting from delayed management. Clinician perspectives to identify system challenges, vulnerable situations, and potential solutions were sought in focus groups. METHODS: Five semistructured focus groups were conducted in 2015 with purposefully sampled clinicians from radiology, hospital medicine, emergency medicine, risk management, and ambulatory care from an urban, academic, integrated, safety-net health system. Thematic analysis identified challenges of current management of abnormal subcritical tests, vulnerable situations, and solution characteristics. A total of 43 clinicians participated. RESULTS: Clinicians cited challenges in assigning responsibility for follow-up and identified tests pending at discharge and tests requiring delayed follow-up as vulnerable situations. The lack of tracking systems and missing contact information for patients and providers exacerbated these challenges. Proposed solution characteristics involved protocols to aid in assigning responsibility, reliable paths of communication, and systems to track the status of tests. Clinicians noted a strong desire for integration of the work flow and technology solutions into existing structures. CONCLUSION: In an urban safety-net setting, clinicians recommended outlining clear chains of responsibility and communication in the management of subcritical test results, and employing simple, integrated technological solutions that allow for tracking and management of tests. Existing test management solutions should be adapted to work within safety-net systems, which often have fewer resources and more complex patients and may function in the absence of integrated technology systems.
Authors: Eric G Poon; Barry Blumenfeld; Claus Hamann; Alexander Turchin; Erin Graydon-Baker; Patricia C McCarthy; John Poikonen; Perry Mar; Jeffrey L Schnipper; Robert K Hallisey; Sandra Smith; Christine McCormack; Marilyn Paterno; Christopher M Coley; Andrew Karson; Henry C Chueh; Cheryl Van Putten; Sally G Millar; Margaret Clapp; Ishir Bhan; Gregg S Meyer; Tejal K Gandhi; Carol A Broverman Journal: J Am Med Inform Assoc Date: 2006 Nov-Dec Impact factor: 4.497
Authors: Courtney R Lyles; Veenu Aulakh; Wendy Jameson; Dean Schillinger; Hal Yee; Urmimala Sarkar Journal: Am J Med Qual Date: 2013-10-29 Impact factor: 1.852
Authors: Hardeep Singh; Eric J Thomas; Dean F Sittig; Lindsey Wilson; Donna Espadas; Myrna M Khan; Laura A Petersen Journal: Am J Med Date: 2010-03 Impact factor: 4.965
Authors: Traber Davis Giardina; Beth J King; Aartee P Ignaczak; Douglas E Paull; Laura Hoeksema; Peter D Mills; Julia Neily; Robin R Hemphill; Hardeep Singh Journal: Health Aff (Millwood) Date: 2013-08 Impact factor: 6.301