Lab tests not always checked before patients get discharged

By Nicole Ostrow
Posted9/17/2012 6:00 AM

Doctors who order tests for hospital patients don't always read the results before the patient is discharged, raising the risk of missing potentially dangerous conditions, an Australian study found.

About half of the unread tests were ordered on the day the patient left the hospital, according to research in the Archives of Internal Medicine. Many of those results still hadn't been reviewed two months later, the researchers said.

NYU Langone Medical Center said it changed policies last month after a 12-year-old boy died following his discharge from the hospital's emergency room. Doctors didn't follow up on blood tests taken before the boy left indicating he had sepsis and he later died from septic shock, The New York Times reported. The study shows that doctors need to better manage the tests they order, including using electronic alerts, and patients should follow up and make sure they get results, said Enrico Coiera, the study author.

"Through this study, by identifying the key role of tests close to and on discharge day, we now have a real opportunity to directly deal with this problem of missed test results, because its cause and cure is now much clearer," Coiera, director of the Center for Health Informatics at the University of New South Wales in Sydney, said in an email. "The next steps for us are to see what we can do to fix this problem."

Researchers looked at 6,736 inpatient admissions and 662,858 individual medical tests. Of those tests, 3 percent weren't reviewed at discharge and 7 percent were requested on the day the patient was leaving the hospital.

About 47 percent of unread tests were from those done on the day the patient left the hospital, the study found. Of the unread tests, 41 percent still hadn't been reviewed two months later, the authors said.

Coiera said doctors may not look at test results because some are routine screenings that are ordered before the doctor knows a patient is being discharged. Other times, no one takes responsibility to follow up on tests that come in long after a patient has gone home, he said.

"For doctors, the message is that in our study, close to half of the tests ordered on the day of discharge are never looked at again. Some of these are unnecessary tests and represent a major opportunity to save on costs," Coiera said. "Others are clinically significant and should be followed up. Actively managing tests ordered on, or close to, discharge day should thus have a major impact on the persistent problem of failure to follow up test results, improving care quality and reducing costs."

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