EHR帮助识别错误检查结果

张琨

Abnormal Test Results May Not Get to Patients By NICHOLAS BAKALAR
If you think your doctor will automatically tell you if you have an abnormal test result, think again. Researchers studying office procedures among primary care physicians found evidence that more than 7 percent of clinically significant findings were never reported to the patient.
The scientists, led by Dr. Lawrence P. Casalino, an associate professor at Weill Cornell Medical College, reviewed the records of 5,434 patients at 19 independent primary care practices and four based in academic medical centers. They extracted records that contained abnormal results for blood tests or X-rays and other imaging studies, and then searched for documentation that the patient had been properly informed of the problem in a timely way.
Then they surveyed the doctors with uninformed patients. Some told them that the patient had been informed, even though there was no documentation, while others believed the results were not significant and therefore required no notification. In a few cases, the doctor said that the patient had not yet been informed but soon would be. After accounting for these and other ambiguous cases, the researchers found that of 1,889 abnormal results, there were 135 failures to inform.
Results varied widely among the primary care practices, and all but the smallest — those with fewer than eight doctors — had at least one failure. In two of the largest academic medical centers, with a combined 80 primary care specialists, 23 percent of abnormal results were never mentioned to the patients.
Dr. Eric G. Poon, director of clinical informatics at Brigham and Women’s Hospital in Boston, who was not involved in the work, said it was a high-quality study with good methodology. “You go to the doctor and you get tests and assume that there is a right way for the doctor to look at the results and to act on them quickly,” he said. “But the truth of the matter is that a lot of things can fall through the cracks. Information is handed down from one person to another to another before the doctor actually sees it.”
Unsurprisingly, practices that used electronic medical records had lower failure rates than those that used only paper documents. But offices that used a combination of paper and computer records had the worst results of all.
Using information from a study of the literature and an earlier pilot study, the authors concluded that following five relatively simple procedures could eliminate most errors: results are routed to the responsible doctor, the doctor signs off on them, the office informs patients of all results, the practice documents that patients have been informed, and finally patients are told to call after a certain time interval if they have not learned the results of their tests. Most practices examined in the current study, published Monday in The Archives of Internal Medicine, failed to follow those steps.
The authors acknowledge that their sample was self-selected — offices volunteered to participate — and included only 23 practices. A random sample of offices, or a larger number of them, they write, could have produced different results.
Although some doctors may have informed their patients without documenting it, Dr. Casalino said that failure to document is almost as bad as failing to inform. “If what happens doesn’t get documented,” he said, “it can be very confusing when the patient next needs to be taken care of.”
For patients, Dr. Casalino said, the message is simple. “Don’t assume that ‘no news is good news’ when you have tests done. That’s a very dangerous assumption. If you’ve had a test done and you don’t hear about it after a week or two goes by, call the doctor’s office.”