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Test Anxiety

By Jock Hoffman, CRICO

Related to: Clinical Guidelines, Communication, Diagnosis


Errors related to testing, both screening and diagnostic, are a significant factor in medical malpractice cases alleging a missed or delayed diagnosis. According to a recent study of family practice physicians, one test-related error occurred for every 30 patient visits. These costly missteps span the diagnostic process from failing to order the right test at the right time, to misinterpretation of the findings, to miscommunication of the results (both among providers and to patients).

This last area, test result management and communication, is the biggest concern for labs, physicians, patients…and malpractice insurers. In one study, 57 percent of physicians reported being dissatisfied with how they managed test results for their patients. Across the CRICO-insured settings, miscommunicated test results represent more than $39 million in incurred losses for 54 cases asserted from January 2003 to June 2008. More than three-quarters of those 54 events involved a high-severity injury outcome. The largest percentage of those cases involved outpatients. The physician specialty most commonly named in cases involving miscommunicated test results was general medicine.

Our Recommendation

It is not for lack of trying to resolve it that this problem persists. But from yellow stickies and 20th Century tickler files to 21st Century results management systems, the goal of closing the loop on ordered tests remains elusive. Physicians in outpatient settings often find that non-electronic systems are easier to implement, maintain, and tweak than the electronic options. Of course, with advancing technology, automated results management is bound to become mainstream. From the patient safety perspective, the type of system you use to keep track of test results is less important than being certain that it has the following components:

Decision support tools to assist in accurately determining the appropriate diagnostic tests. 
Protocols and algorithms can assist in providing an objective sounding board to reinforce decision making.

The rationale for testing is explained to the patient. 
Promotes a sense of partnership and encourages compliance with follow through.

A practice-based process to reconcile incoming test results with requests. 
Especially important for practices using several vendors for diagnostic testing. This process should highlight test results that are deemed critical in diagnosing serious conditions.

Follow-up plan with corresponding documentation.
Successful systems ensure that tests, especially abnormal tests, are brought to the ordering physician’s attention in a timely manner. Documenting the follow up plan is an important step in minimizing liability.

A policy for patient notification of ALL test results. 
Setting an expectation with patients that they should receive notification of their test results promotes a sense of partnership and engagement. In addition, patients can serve as the final check ensuring that results have not been “lost along the way.”

Additional Materials

September 1, 2008
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