Home from the Hospital: Almost Half of Patients are Discharged with Test Results Still Pending
Boston, MA - A patient hospitalized for a week may undergo hundreds of tests. It is common practice to discharge a patient while some of these test results are still pending, but how this impacts patient safety is not well known. Now, for the first time, researchers from Brigham and Women's Hospital (BWH) and Massachusetts General Hospital (MGH), have analyzed how often results are left pending and how they impact a patient's care plan. The data is published in the July 19, 2005 issue of the Annals of Internal Medicine.
According to Christopher Roy, MD, a hospitalist at BWH who studies patient safety "The hand-off from hospital care givers to the primary care physician is a critical time to promote patient safety, so the purpose of this study was to put the discharge process under a microscope so we can better understand the prevalence, characteristics, and implications of tests that are still pending when a patient is sent home. We found that while approximately half of the patients in this study had test results that were unavailable at discharge, only a very small percentage of pending results impacted the patient's care plan."
The researchers followed 2,644 consecutive, discharged patients from two hospitals between February and June 2004. They found that 41 percent of patients left the hospital before all imaging and laboratory test results were reported.
Additionally, the study found:
· 1,095 patients (41 percent) had 2,033 test results pending at the time of discharge.
· Of the pending results, 191 (nine percent) were rated "potentially actionable" by the researchers, meaning they could have altered the patient's care plan.
· Physician awareness of these "potentially actionable" results was low. Surveyed physicians were unaware of 65 potentially actionable results.
· Of these 65 results, surveyed physicians agreed that 24 results required clinical action and eight results required "urgent clinical action." For example, one result revealed that a patient had an infection with a bacteria that was resistant to the antibiotic they were taking.
The researchers indicate that while the actual number of clinically significant test results left pending was very small, the potential for consequences to all hospitalized patients is significant. After extrapolating the findings, Roy found that in a hospital with 30,000 patients discharged per year, there could be 270 missed, actionable test results.
"Patients who are medically stable and ready to leave the hospital are not prevented from doing so if some results are still pending," said Roy. "But now, based on this data, we recognize the large number of patients who fall into this category, so it is crucial that doctors be prepared to carefully manage the flow of discharge information to minimize potential errors. This paper is a call to action to hospitals to help build systems that support the safe and efficient transfer of test result data. Importantly, patients can also play a role in promoting safety associated with test information. It is critical patients evaluate and understand their discharge instructions and ask about any results that may be still pending. They should never assume that no news is good news when it comes to waiting for a test result."
Please contact BWH Media Relations for more information at (617) 534-1600 or BWHMediaRelations@partners.org.
BWH is a 747-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare System, an integrated health care delivery network. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832 and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives, dedication to educating and training health care professionals, and strength in biomedical research. With $370M in funding and more than 500 research scientists, BWH is an acclaimed leader in clinical, basic and epidemiological investigation - including the landmark Nurses Health Study, Physicians Health Studies, and the Women's Health Initiative. For more information visit www.brighamandwomens.org
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