“I Wish I Had Seen This Test Result Earlier!”: Dissatisfaction With Test Result Management Systems in Primary Care
Open accessAbstract
BACKGROUND: Failure to review and follow up on outpatient test results in a timely manner represents a patient safety and malpractice concern. Therefore, we sought to identify problems in current test result management systems and possible ways to improve these systems. METHODS: We surveyed 262 physicians working in 15 internal medicine practices affiliated with 2 large urban teaching hospitals (response rate, 64%). We asked physicians about systems they used and the amount of time they spent managing test results. We asked them to report delays in reviewing test results and their overall satisfaction with their management of test results. We also asked physicians to rate features they would find useful in a new test result management system. RESULTS: Overall, 83% of respondents reported at least 1 delay in reviewing test results during the previous 2 months. Despite reporting that they spent on average 74 minutes per clinical day managing test results, only 41% of physicians reported being satisfied with how they managed test results. Satisfaction was associated with fewer self-reported delays in reviewing test results. Physicians who actively tracked their test orders to completion were also more likely to be satisfied. The most highly desired features of a test result management system were tools to help physicians generate result letters to patients, prioritize their workflow, and track test orders to completion. CONCLUSIONS: Delays in test result review are common, and many physicians are not satisfied with how they manage test results. Tools to improve test result management in office practices need to improve workflow efficiency and track test orders to completion.
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Even in the EHR environment, with alerts and reminders in place, physicians continue to often inappropriately manage abnormal test results.
“Even in the EHR environment, with alerts and reminders in place, physicians continue to often inappropriately manage abnormal test results.12,13,14,15,16,17,18,19,20,21”
From Association of the Usability of Electronic Health Records With Cognitive Workload and Performance Levels Among Physicians (2019) · cites this paper as [13]
The COMMENT section reports frequent delays in reviewing test results and significant deficiencies in ambulatory test-result management. But the paper does not establish that these problems persisted despite EHR alerts and reminders: TEST RESULT MANAGEMENT SYSTEMS IN PLACE describes an electronic-medical-record to-do list used by some physicians, while COMMENT proposes automated warnings as a desired feature. Page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredA sample size of 30 participants, each reviewing 35 test results, was required to achieve 80% power to detect a statistically significant difference in cognitive workload and performance.
“On the basis of the anticipated rate of appropriately identified abnormal test results in the literature12,13,14,15,16,17,18,19,20,21 and the anticipated magnitude of the association of the enhanced EHR, we required a sample size of 30 participants, each reviewing 35 test results, to achieve 80% power to detect a statistically significant difference in cognitive workload and performance.”
From Association of the Usability of Electronic Health Records With Cognitive Workload and Performance Levels Among Physicians (2019) · cites this paper as [13]
The citation is attached to the anticipated rate of appropriately identified abnormal test results, not to the citing authors’ sample-size calculation. The source’s “Test Result Management Systems in Place” section reports physicians’ follow-up systems, but our copy gives no rate of appropriately identified abnormal results. Its “Data Analysis” section also contains no 30-participant, 35-result, or 80%-power calculation. (LLM, conf=0.75)
Experimental — accuracy not yet measuredOutpatient care is often busy and fragmented, making follow-up of abnormal laboratory test results prone to error.
“Outpatient care is often busy and fragmented, and therefore follow-up of abnormal laboratory test results is prone to error.”
From Notification of Abnormal Lab Test Results in an Electronic Medical Record: Do Any Safety Concerns Remain? (2010) · cites this paper as [4]
Missed laboratory results or delayed recognition of results creates a significant potential for outpatient diagnostic errors, adverse events, and liability claims.
“missed laboratory results or delayed recognition of results leads to a significant potential for outpatient diagnostic errors, adverse events and liability claims.”
From Notification of Abnormal Lab Test Results in an Electronic Medical Record: Do Any Safety Concerns Remain? (2010) · cites this paper as [4]
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References 19 · Cited by 301
Research works printed but not linked: 3
- Risk Management Foundation. Reducing office practice risks. Forum. 2000;20:2.
- Reason J. Human Error. Cambridge, England: Cambridge University Press; 1990.
- Harbrecht MG. Using a comprehensive breast program to illustrate ways to improve patient safety. Paper presented at: National Ambulatory Primary Care Research and Education Conference on Patient Safety; September 18, 2003; Chicago, Ill.
- Authors
- Poon, E. G., Gandhi, T. K., Sequist, T. D., Murff, H. J., Karson, A. S., & Bates, D. W.
- Affiliations
- Brigham and Women's Hospital (US)
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2004-11-08
- Volume
- 164
- Issue
- 20
- Pages
- 2223
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2127579435
- Cited by
- 301
- References
- 19
- Citations by year
- 2026: 4 · 2024: 5 · 2023: 7 · 2022: 5 · 2021: 13 · 2020: 8 · 2019: 19 · 2018: 12 · 2017: 19 · 2016: 10 · 2015: 29 · 2014: 26 · 2013: 18 · 2012: 11
- FWCI
- 9.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (R01 1U18 HS 11046-03)
- Topics
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Keywords
- test result management, physician satisfaction, patient safety, medical malpractice, internal medicine practice, workflow efficiency, physician time use
- MeSH terms
- Adult, Attitude of Health Personnel, Clinical Competence, Continuity of Patient Care, Female, Hospitals, Teaching, Humans, Internal Medicine, Job Satisfaction, Male, Middle Aged, Office Management, Probability, Time Factors, Multicenter Studies as Topic, Logistic Models, Medical Records Systems, Computerized, Outcome Assessment, Health Care, Clinical Laboratory Techniques, Health Care Surveys
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