Introduction
Reporting and follow-up of test results are critical components of healthcare safety in the United States of America, and has raised concern regarding patient safety in the U.S healthcare system in recent years (Singh et al., 2022). reporting and follow-up of test results is one area that warrants special attention. According to Scott & Crock (2020), serious medical mistakes like delayed or missed diagnoses, ineffective treatments, and patient injury, can come from improperly reporting and following up on test results. Effective communication of test results between healthcare providers and patients is essential for timely diagnosis, treatment, and prevention of adverse outcomes. The timely communication of test results between healthcare providers and patients is essential for effective diagnosis, treatment, and prevention of adverse outcomes. Delayed or missed communication of test results can lead to serious consequences, including misdiagnosis, delayed treatment, and even death (Newman-Toker et al., 2019), while, effective test result reporting and follow-up can improve patient outcomes, reduce healthcare costs, and enhance patient satisfaction. The significance of efficient test result reporting and follow-up and its effects on patient safety in the United States will be discussed in this essay. The essay will also highlight the difficulties that healthcare practitioners encounter in guaranteeing prompt and precise reporting and propose possible improvements to the procedure.
Threat towards patient safety
The inadequacy of test result reporting and patient follow-up is one core elements of healthcare safety which has gained considerable attention in recent years, where healthcare safety in the United States is of crucial concern. On one hand, the collection of test results is now more effective than ever due to a widespread use of electronic health records and cutting-edge medical advancements. However, the correct management of the test data, is not up to date, which has led to an enormous problem of missed or delayed diagnoses and lack of follow-up by patients. For patients and their caretakers, the effects of such mistakes may be catastrophic, resulting in a chronic illness, disabilities, or even death. Additionally, negligence caused due to a lack of test reporting and patient follow-up can result in monetary and legal implications for healthcare professionals and organizations, undermining their image and financial safety. To safeguard the security and welfare of patients, it is crucial to solve this issue as quickly as feasible.
A grave safety concern that has been highlighted as a significant issue in clinical settings is the inability to follow up on test findings. Physicians and patients agree that the existing techniques and procedures in testing and follow-up need to be improved since they are inconsistent and variable. There are three primary phases in each test procedure including pre-analytic, analytic, and post-analytic that make up the testing process. Each phase involves several steps and several people, including physicians, patients, administrative, and laboratory employees. Currently in the United States, most primary healthcare facilities do not utilize electronic records of health care, and most are dealing with several laboratories that are not digitally connected. Doctors are under additional stress due to rising test numbers and the time-consuming complexity of test follow-up.
Delayed or missed diagnosis can has an influence on patient care and have medical repercussions for medical services and medical workers if follow-up is not done. Many healthcare professionals underestimate the severity of the issue because they are unaware of it, thus failing to take any measures to improve the follow-up after test reporting. In addition to the numerous difficulties inherent in hospitals and other acute healthcare environments, there are unique difficulties for efficient test administration. Findings by Li et al (2019) concluded that there has been very little research done on the nature of this problem in the healthcare system in the United States, therefore the aim of this paper to understand test reporting and follow-up that defines the scale and effects on patient outcomes due to failure to follow-up test findings.
Trends in the United States today
The safety of healthcare in the United States is seriously threatened by a lack of test result reporting and patient follow-up Fixing healthcare safety through test result reporting and follow-up needs a collaborative initiative from all stakeholders, particularly healthcare professionals, organizations, and legislators, to guarantee that patients access prompt and correct diagnoses and treatments, Health care professionals, legislators, academics, insurers, patients, and other stakeholders committed to enhancing patient safety and the standard of care in the United States often benefit from the information provided by state and national standards. The AHRQ Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), which account for more than 97 percent of all yearly releases in the United States, were analyzed to produce national and state standards (Meier et al., 2022). The standards give hospitals a point of comparison to evaluate their own effectiveness and pinpoint opportunities for development. The data showed that on patient safety indicators, the U.S. received a score of 53 out of 100. This was below the overall average rating for the overall performance of the health system, at 64. Also, the United States also came in bottom place between several 11 high-income nations for patient safety outcomes including mortality treatable by medical treatment, test result communication and immediate patient follow-up.
Moreso, The United States Health Information Technology for Economic and Clinical Health (HITECH) Act emphasizes how critical it is to offer patients electronic access to their medical records and rewards it as component of the stage 2 “meaningful use” requirements (HITECH Act, 2023). Many test results are now being easily accessed by patients via secure internet interfaces within four days of becoming available to adhere to meaningful use criteria and promote openness. However, according to Lee & Lee (2020), although direct reporting is becoming more prevalent in the U.S and international health care systems, there is no empirical data to support its usage. Dahm et al (2018) highlighted the growing evidence that healthcare providers and patients have different opinions regarding the time of direct test result notification, with patients advocating an instantaneous notice and doctors favoring a seven-day embargo. Different views on direct communication using patient portals may cause inconsistent use, a failure to accept this emerging innovations, or other possible effects that might have an impact on patient care. Considering the most current meaningful use requirements, it is important to better understand the variables that might affect the broad adoption and usage of direct notification.
Challenges and Barriers to Test Result Reporting and Follow-Up
Test findings and failure to follow up on test results are well-known to pose serious risks to patient safety. Müller et al (2020) found that despite improper handling of diagnostic test findings can cause patient injury or even death, injury is preventable in most of the claims. Patient safety may be enhanced in the domain of preventable injury, and several treatments have been studied with the goal of enhancing safety by upgrading test-results follow-up. Patients also have a stake in the efficient management and dissemination of their test results as the beneficiaries of clinical examination. Also, it is acknowledged that patients who request or examine findings may act as a backup plan in case test results are overlooked. Most studies on patient engagement in test operations have looked at patient needs for communicating test findings or patient satisfaction with getting test results. Primary care facilities have evaluated patient outcomes with the entire testing process or results handling, highlighting reliable and secure patterns and possible opportunities for operational quality management.
Difficulties in medical care may leads to patient harm if individuals are not informed of their negative test findings or are not followed up upon (i.e., “missing” test results). Follow-up on abnormal lab findings is frequently delayed, which is worrying. An extensive range of missing abnormal findings, including 6.8–62% missing test result were reported in a recent systematic study of outpatient laboratory results follow-up. The importance of this issue is revealed through underlying problem assessment studies and malpractice lawsuits. Systems for notifying patients of test results have been criticized by doctors. Even though doctors are increasingly being notified of aberrant test findings via electronic health records, follow-up failures still happen. Despite its importance, test result reporting and follow-up continue to pose significant challenges and barriers in healthcare settings including the following.
Communication breakdowns between healthcare providers and patients, as well as among healthcare providers themselves, can lead to delayed or missed test result reporting and follow-up. It takes a lot of communication to follow up on test findings. Apparent breakdowns in communication between patients and healthcare providers have a significant impact on patient safety. Often in contexts where patients may be released with delayed test results, there is some misunderstanding over job definition and expectations among the healthcare staff concerning test results communication and follow-up. Thus, there is a critical patient safety concern is raised because of the absence of follow-up.
Electronic health record (EHR) systems have revolutionized healthcare, but they also pose challenges to effective test result reporting and follow-up. Providers may fail to receive timely alerts about abnormal test results, or they may overlook them among a sea of other alerts. Even though doctors can digitally confirm their having accessed an alert, it does not guarantee their response to the aberrant result. to provide adequate follow-up, a doctor must evaluate the results, notify the patient of them, choose an acceptable plan, review the results, procedure, and way forward with the patient, and assist them in choosing the best course of action. However, it is not the case as the adoption of technology has alienated the need for one-on-one patient-doctor communication which most studies show is essential in creating a patient-based form of care and an increase follow-up.
Patient factors: Patient factors, such as language barriers, health literacy, and access to healthcare, can all contribute to challenges in test result reporting and follow-up. Patients may miss appointments or fail to follow up on test results due to financial or logistical barriers. An essential problem, namely the patient’s participation in results follow-up, was discovered through Palmer (2019) comprehensively analyzed patient-related elements effecting test-results follow-up and found that individuals portrayed patient engagement as a continuum spanning from patients who anticipate a physician’s call to patients who assume the responsibility for following up on outcomes. There is a need to find out and standardize who is in charge of guaranteeing that the test results are followed up on. It is a long-standing and ubiquitous issue in healthcare where patients are not informed on the process, fees and commitment on what it entails to follow-up and whose responsibility it is to communicate the test results.
Strategies for Improving Test Result Reporting and Follow-Up
Improvements in test result reporting and follow-up are necessary to guarantee patient ’s safety in the United States. Timely communication of test findings to both patients and healthcare professionals is essential for optimal care since test results are a key factor in choices about diagnosis and treatment. Regrettably, there are a number of issues with the way test findings are currently reported and followed, including poor communication, missing or delayed test results, and insufficient surveillance and oversight. Some measures that can be adopted in enhancing test result reporting, follow-up, for patient safety are as follows.
Use of technology
Patients and healthcare professionals can leverage the use of technology. To enhance the reporting and follow-up of test results, healthcare institutions should make more efficient use of technologies such as EHRs and patient portals. Digitalized solutions allow patients conveniently obtain their test findings and also inform healthcare professionals about abnormal test results. According to Apathy, Holmgren & Adler-Milstein (2021), EHR systems have transformed healthcare and have recently begun to be utilized in the U.S to enhance test result reporting and follow-up. When unexpected test results are discovered, EHR systems can automatically notify healthcare professionals, guaranteeing prompt results reporting. With patient portals, they may also give patients simple accessibility to their test findings.
Moreso, a reliable electronic health record (EHR) system ranks among the key techniques for enhancing test result reporting and follow-up (Haleem et al., 2021). With a reliable EHR system in place, patients can get their test results digitally and clinicians can access them instantly, automatically send notifications to patients as well as healthcare professionals for follow-up visits or further testing and store and monitor test findings, enabling healthcare professionals to quickly see any missed or delayed results and take appropriate action. Even so, Georgiou et al (2019) documented through a systematic review how the adoption of EHR systems enhances test result reporting and follow-up and lowers the probability of adverse effects from the lack of reporting.
Standardizing processes of test-result communication and follow-up
Mikhaeil et al (2021) found that it is possible to prevent communication failures and guarantee fast and efficient test result communication and increase of patient follow-up through by streamlining test result reporting and follow-up procedures in every healthcare facility in the country. Currently, guidelines for test result reporting and follow-up have been set by The Joint Commission, a non – profit organization that accredits and certifies healthcare institutions. According to TJC r requirements, healthcare institutions must establish guidelines and procedures for promptly informing both patients and healthcare professionals of test findings (National Patient Safety Goals, 2023). Moreover, they mandate that healthcare institutions monitor and record test result follow-up to guarantee that patients get the adequate care.
Setting up specific guidelines and procedures for reporting and following up on test results is another crucial approach. The obligations of physicians, patients, and support personnel like nurses, medical assistants, and admin must be outlined in these policies. Also, the standardized guidelines must specify the timing and manner in which to engage patients and follow up on findings that are abnormal or important. They should also provide recommendations for prompt disclosure of results. Mayer, D. K., & Alfano, C. M. (2019) advised on the inclusion of management and surveillance of test results to ensure prompt follow-up and lower the possibility of missing or delayed findings,
Patient education, communication and engagement
Another tactic for enhancing patient safety, detailed by Han et al (2019), is to involve patients in the reporting and follow-up of test results. Patients must be taught how to obtain their test results electronically and also be made aware of the value of follow-up consultations. Furthermore, patients must be urged to consult their providers as soon as they have any issues or symptoms and to inquire about their test findings. Based on their test results, patients can participate in participatory decision concerning medical tests or treatment options. Improved patient engagement and education can assist in removing patient-related obstacles to the reporting and follow-up of test results. Healthcare professionals must inform patients about the value of test result follow-up and offer tools and resources they need to conveniently obtain their findings.
Effective test result reporting and follow-up requires cooperation and communication between healthcare professionals, patients, and support personnel (Burgener, 2020). Test findings must be promptly and efficiently communicated by physicians to patients and relevant healthcare professionals engaged in their treatment. to guarantee that test findings are correctly understood and properly incorporated in a patient’s treatment plan, healthcare professionals can engage in inter-professional communication. Support workers, like nurses and medical assistants, should receive training on how to relay test results clearly and precisely and how to report on any missing or delayed test results (Choo et al., 2019).
Quality Improvement
The reporting and follow-up of test results and patient safety can be improved by continuing quality improvement programs. According to Royce, Hayes & Schwartzstein (2019), efforts towards quality improvement regularly monitor and evaluate the reporting and follow-up of test results, highlighting opportunities for improvement, and establishing measures to deal with any discovered gaps or difficulties. Moreover, quality improvement efforts should also include continual training and development for healthcare professionals and administrative personnel, including the best methods for patient communication and presenting of test results.
Conclusion
Enhancing test result reporting and follow-up is critical to maintain patient ’s safety in the United States. Patients define health safety concerns by delayed information accessibility, including effects on decision-making and observations of misdiagnosis or missed laboratory test information in their treatment. These patients are aware of the interlinkages between doctor communication and information, and they understand this relationship. Thus, the issues can be addressed and patient outcomes improved by developing a strong EHR system, creating clear guidelines and procedures, involving patients, communication and collaboration, and continual quality improvement programs. However, in the past, physicians in the United States had not yet adopted electronic access to share test findings and patient health data, yet consumers saw this technology as facilitating knowledge access and communication. It is important that patients be made aware of the significance of health resources to aid in comprehending medical information for example acronym definitions, to gain a better understanding of test results and as trustworthy sources for additional assistance. Despite the challenges and barriers associated with test result reporting and follow-up, healthcare providers and organizations can implement strategies to improve it. Patient safety must be prioritized as the healthcare systems develop through offering efficient test result reporting and follow-up processes to their consumers.
References
Apathy, N. C., Holmgren, A. J., & Adler-Milstein, J. (2021). A decade post-HITECH: Critical access hospitals have electronic health records but struggle to keep up with other advanced functions. Journal of the American Medical Informatics Association, 28(9), 1947-1954. https://doi.org/10.1093/jamia/ocab102
Burgener, A. M. (2020). Enhancing communication to improve patient safety and to increase patient satisfaction. The health care manager, 39(3), 128-132. DOI: 10.1097/HCM.0000000000000298
Choo, Y. Y., Agarwal, P., How, C. H., & Yeleswarapu, S. P. (2019). Developmental delay: identification and management at primary care level. Singapore medical journal, 60(3), 119. doi: 10.11622/smedj.2019025
Dahm, M. R., Georgiou, A., Westbrook, J. I., Greenfield, D., Horvath, A. R., Wakefield, D., Li, L., Hillman, K., Bolton, P., Brown, A., Jones, G., Herkes, R., Lindeman, R., Legg, M., Makeham, M., Moses, D., Badmus, D., Campbell, C., Hardie, R. A., Li, J., … Wabe, N. (2018). Delivering safe and effective test-result communication, management and follow-up: a mixed-methods study protocol. BMJ open, 8(2), e020235. https://doi.org/10.1136/bmjopen-2017-020235
Georgiou, A., Li, J., Thomas, J., Dahm, M. R., & Westbrook, J. I. (2019). The impact of health information technology on the management and follow-up of test results–a systematic review. Journal of the American Medical Informatics Association, 26(7), 678-688. https://doi.org/10.1093/jamia/ocz032
Haleem, A., Javaid, M., Singh, R. P., & Suman, R. (2021). Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sensors international, 2, 100117. https://doi.org/10.1016/j.sintl.2021.100117
HITECH Act (2023). HITECH Act Summary: HIPAA Survival Guide, 4th Edition. Retrieved https://www.hipaasurvivalguide.com/hitech-act-summary.php
Han, H. R., Gleason, K. T., Sun, C. A., Miller, H. N., Kang, S. J., Chow, S., … & Bauer, T. (2019). Using patient portals to improve patient outcomes: systematic review. JMIR human factors, 6(4), e15038. doi: 10.2196/15038
Lee, S. M., & Lee, D. (2020). Healthcare wearable devices: an analysis of key factors for continuous use intention. Service Business, 14(4), 503-531. https://doi.org/10.1007/s11628-020-00428-3
Li, D. R., Brennan, J. J., Kreshak, A. A., Castillo, E. M., & Vilke, G. M. (2019). Patients who leave the emergency department without being seen and their follow-up behavior: a retrospective descriptive analysis. The Journal of Emergency Medicine, 57(1), 106-113. https://doi.org/10.1016/j.jemermed.2019.03.051
Mayer, D. K., & Alfano, C. M. (2019). Personalized risk-stratified cancer follow-up care: its potential for healthier survivors, happier clinicians, and lower costs. JNCI: Journal of the National Cancer Institute, 111(5), 442-448. https://doi.org/10.1093/jnci/djy232
Meier, S. K., Pollock, B. D., Kurtz, S. M., & Lau, E. (2022). State and Government Administrative Databases: Medicare, National Inpatient Sample (NIS), and State Inpatient Databases (SID) Programs. JBJS, 104(Suppl 3), 4-8. DOI: 10.2106/JBJS.22.00620
Mikhaeil, J. S., Jalali, H., Orchanian-Cheff, A., & Chartier, L. B. (2020). Quality assurance processes ensuring appropriate follow-up of test results pending at discharge in emergency departments: a systematic review. Annals of Emergency Medicine, 76(5), 659-674. https://doi.org/10.1016/j.annemergmed.2020.07.024
Müller, B. S., Donner-Banzhoff, N., Beyer, M., Haasenritter, J., Müller, A., & Seifart, C. (2020). Regret among primary care physicians: a survey of diagnostic decisions. BMC Family Practice, 21(1), 1-7. https://doi.org/10.1186/s12875-020-01125-w
National Patient Safety Goals (2023). The Joint Commission. Retrieved https://www.jointcommission.org/standards/national-patient-safety-goals/
Newman-Toker, D. E., Wang, Z., Zhu, Y., Nassery, N., Tehrani, A. S. S., Schaffer, A. C., … & Siegal, D. (2021). Rate of diagnostic errors and serious misdiagnosis-related harms for major vascular events, infections, and cancers: toward a national incidence estimate using the “Big Three”. Diagnosis, 8(1), 67-84. https://doi.org/10.1515/dx-2019-0104
Palmer, O. M. P. (2019). Effect of patient-related factors on clinical laboratory test results. In Accurate Results in the Clinical Laboratory (pp. 45-56). Elsevier. https://doi.org/10.1016/B978-0-12-813776-5.00004-2
Royce, C. S., Hayes, M. M., & Schwartzstein, R. M. (2019). Teaching critical thinking: a case for instruction in cognitive biases to reduce diagnostic errors and improve patient safety. Academic Medicine, 94(2), 187-194. DOI: 10.1097/ACM.0000000000002518
Scott, I. A., & Crock, C. (2020). Diagnostic error: incidence, impacts, causes and preventive strategies. Medical Journal of Australia, 213(7), 302-305. doi: 10.5694/mja2.50771
Singh, H., Mushtaq, U., Marinez, A., Shahid, U., Huebner, J., McGaffigan, P., & Upadhyay, D. K. (2022). Developing the Safer Dx Checklist of ten safety recommendations for health care organizations to address diagnostic errors. The Joint Commission Journal on Quality and Patient Safety, 48(11), 581-590. https://doi.org/10.1016/j.jcjq.2022.08.003
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