Deevakar Rogith1, Tyler Satterly2,3, Hardeep Singh2,3, Dean F Sittig1,4, Elise Russo5, Michael W Smith6, Don Roosan7, Viraj Bhise8, Daniel R Murphy2,3. 1. The University of Texas Health Science Center at Houston School of Biomedical Informatics, Houston, Texas, United States. 2. Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veteran Affairs Medical Center, Houston, Texas, United States. 3. Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, United States. 4. UT-Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas, United States. 5. Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States. 6. Department of Industrial and Mechanical Engineering, Universidad de las Americas Puebla, Cholula, Mexico. 7. Department of Pharmacy Practice and Administration, College of Pharmacy Western University of Health Sciences, Pomona, California, United States. 8. Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States.
Abstract
OBJECTIVE: This study demonstrates application of human factors methods for understanding causes for lack of timely follow-up of abnormal test results ("missed results") in outpatient settings. METHODS: We identified 30 cases of missed test results by querying electronic health record data, developed a critical decision method (CDM)-based interview guide to understand decision-making processes, and interviewed physicians who ordered these tests. We analyzed transcribed responses using a contextual inquiry (CI)-based methodology to identify contextual factors contributing to missed results. We then developed a CI-based flow model and conducted a fault tree analysis (FTA) to identify hierarchical relationships between factors that delayed action. RESULTS: The flow model highlighted barriers in information flow and decision making, and the hierarchical model identified relationships between contributing factors for delayed action. Key findings including underdeveloped methods to track follow-up, as well as mismatches, in communication channels, timeframes, and expectations between patients and physicians. CONCLUSION: This case report illustrates how human factors-based approaches can enable analysis of contributing factors that lead to missed results, thus informing development of preventive strategies to address them. Georg Thieme Verlag KG Stuttgart · New York.
OBJECTIVE: This study demonstrates application of human factors methods for understanding causes for lack of timely follow-up of abnormal test results ("missed results") in outpatient settings. METHODS: We identified 30 cases of missed test results by querying electronic health record data, developed a critical decision method (CDM)-based interview guide to understand decision-making processes, and interviewed physicians who ordered these tests. We analyzed transcribed responses using a contextual inquiry (CI)-based methodology to identify contextual factors contributing to missed results. We then developed a CI-based flow model and conducted a fault tree analysis (FTA) to identify hierarchical relationships between factors that delayed action. RESULTS: The flow model highlighted barriers in information flow and decision making, and the hierarchical model identified relationships between contributing factors for delayed action. Key findings including underdeveloped methods to track follow-up, as well as mismatches, in communication channels, timeframes, and expectations between patients and physicians. CONCLUSION: This case report illustrates how human factors-based approaches can enable analysis of contributing factors that lead to missed results, thus informing development of preventive strategies to address them. Georg Thieme Verlag KG Stuttgart · New York.
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