Doctors tend not to read the results of medical tests ordered on a patient's last day at the hospital, and this could cause doctors to miss worrisome findings, a new study from Australia suggests.
In the study, 21.3 percent of tests ordered on a patient's last day at the hospital were not reviewed by health care personnel, whereas just 1.8 percent of tests ordered on other days went unread.
Additionally, the researchers found that of all hospital tests that went checked, close to 50 percent were ordered on a patient's last day.
Some tests are ordered automatically, because not everyone involved in a patient's care may be aware that the patient is going home that day, said study researcher Enrico Coiera, director of the Center for Health Informatics at the University of New South Wales in Sydney. "These tests are probably unnecessary, and represent an opportunity for savings," Coiera said.
However, an unreviewed test may also mean a doctor will miss an abnormal result. This problem was highlighted in the recently publicized case of a 12-year-old boy who died of sepsis at a New York hospital. Although several test results might have been warning signs about the boy's condition, those tests allegedly went unchecked.
"People are going home, with clinically abnormal values, and not being followed up," Coiera said. If a test result indicates the presence of a life-threatening condition, such as cancer, the impact of missing that result, and delaying patient treatment, is high, Coiera said.
In the study, tests ordered on the last day were just as likely to have abnormal results as tests ordered on other days, Coiera said.
Coiera and colleagues analyzed information from 6,736 patients who stayed at a metropolitan hospital in Australia between February and June 2011.
The researchers examined computer records of the patients' tests. Test results that had been viewed by a doctor received a time stamp, while unreviewed tests did not receive a time stamp.
During the study period, 662,858 tests were ordered for patients. Of these, 3.1 percent were not reviewed.
Tests ordered on patients' last days made up just 6.8 percent of all tests ordered and performed, but accounted for 46.8 percent of unreviewed tests, the researchers said.
Among the unreveiwed tests ordered on a patients' last day, 14 percent had abnormal results that were not seen by doctors. After two months, 10.8 percent had still not been checked, the researchers found.
What can be done
The findings are concerning, and describe a problem that has been known about for quite some time, said Dr. Christopher Roy, of Brigham and Women's Hospital in Boston.
In 2005, Roy and colleagues conducted a study in which they asked doctors whether they were aware of abnormal results that came back from tests ordered on a patient's last day at the hospital. Sixty-two percent of doctors surveyed said they were not aware of the results, Roy said.
If the results of tests suggest something is wrong, such as signs of an infection, an unreviewed test "could potentially result in patient harm," Roy said.
Roy said his hospital has implemented a system in which results of pending test results are sent by email to the person that discharged the patient once they are available — a system that many are satisfied with.
Better communication between health care professionals about when a particular patient is leaving the hospital may also help reduce unnecessary tests, Coiera said.
The study was published online Aug. 13in the journal Archives of Internal Medicine.
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