Article Figures & Data
Figures
- Figure 1.
Results management steps and specific tasks.
EHR=electronic health record; lab=laboratory; Pap=Papanicolaou.
Tables
Characteristic Office A Office B Office C Office D a Contracts with outside phlebotomy, receptionist, and health system billing. Location Rural Suburban Urban Suburban Clinicians, n Full-time 4 1 2 7 Resident 12 0 0 0 Part-Time 0 3 2 6 Total 16 4 4 13 Women clinicians, n 8 2 3 7 African-American clinicians, n 1 0 1 0 Staff, n Full-time 16 1 9 23 Part-time 4 0 0 2 Total 20 1a 9 25 Patient-payer mix, % Ensured 35 47 24 50 Medicare 30 47 41 45 Medicaid 25 1 17 0 Self-pay 10 1 18 5 Residency practice Yes No No No Electronic health record No Yes No No Outside laboratories used, n 2 2 1 2 Description Office A Office B Office C Office D a Tracking, results return to office, results to physician. b Results return to office, results to physician, physician signature. c Results return to office. Number of results management steps performed in an office that are regularly adhered to, No. (%) 3/8 (37.5)a 3/8 (37.5)b 3/8 (37.5)a 1/8 (12.5)c Number of result management steps for which written protocols exist, No. (%) 2/8 (25) 0/8 (0) 3/8 (37.5) 0/8 (0) Patient survey to assess laboratory testing notification and understanding Participants Survey response rate, No. (%) 27/41 (66) 8/17 (47) 9/19 (47) 19/31 (61) Women, % 81.3 62.5 67.0 89.0 Mean age, y 58.8 50.8 50.4 48.0 Were you told what laboratory tests were being ordered? Yes/total returned, No. (%) 26/27 (96) 8/8 (100) 9/9 (100) 18/19 (95) Have you received the results of the laboratory test? Yes/total returned, No. (%) 27/27 (100) 7/8 (87.5) 9/9 (100) 17/19 (89) Were you given any instructions, advice or information about your test results? Yes/total returned, No. (%) 18/27 (66) 5/8 (62.5) 8/9 (89) 14/19 (74) Chart audit to assess documentation of orders, results, and documentation Is there a test result in the chart for every order? Yes/number of tests ordered, No. (%) 26/30 (87) 55/57 (96) 29/36 (81) 37/41 (90) Are the results located in the appropriate place in the chart yes/number of results, No. (%) 29/31 (81) 55/55 (100) 29/30 (94) 44/44 (100) Is there a clinician signature on each result? Yes/number of results, No. (%) 28/31 (90) 55/55 (100) 26/30 (87) 34/44 (77) Is there documentation in the chart of the clinician’s response to the result? Yes/number of results. No. (%) 26/31 (84) 45/55 (82) 14/30 (47) 33/44 (75) Is there documentation that the patient was notified? Yes/number of results, No. (%) 18/31 (58) 47/55 (85) 23/30 (77) 35/44 (80) Is there documentation that advice, recommendations or information were given to the patient about abnormal results? Yes/number of abnormal results, No. (%) 5/15 (30) 23/42 (55) 5/18 (28) 11/27 (41) - Table 3.
Office Performance of Tasks in the 2 Test Results Management Safety Themes, Safety Awareness and Technological Adoption
Themes and Safety Factors Observed Behaviors in Office Sites for Each Factor Office Sites Where Behaviors Were Observed EHR=electronic health record. a Technology automatically performs a task or requires user to perform a task to move forward. Safety awareness Leadership Leadership often speaks out on safety and quality; backs up words with actions A Leadership occasionally speaks out on safety and quality; occasionally backs up words with actions B, C Leadership rarely speaks out on safety and quality; rarely backs up words with actions D Communication Communication between staff, physicians, and management sometimes occurs often around patient safety and quality, but communication occasionally lacks respect or timeliness; it uses only written and verbal strategies A, B, C Communication between staff, physicians, management, and patients rarely occurs around patient safety and quality and is at times disrespectful and untimely; it uses only written and verbal strategies D Teamwork Teamwork between staff, physicians, and leadership is present in certain areas and tasks A, B, C Teamwork between staff, physicians, and leadership is spotty, occurring only occasionally in certain areas and tasks D Protocols and procedures Procedures and protocols exist for some results management steps, are occasionally evaluated and revised as needed A, C Procedures and protocols do not exist for results management steps B, D Adoption of technology EHR/computer technology No EHR; office computer systems exist for billing, scheduling, and for additional tasks in results management A, C EHR exists and incorporates billing, scheduling, and additional tasks in office management or care of patients B No EHR; computer systems exist for billing and scheduling only D Digital connections Digital connection between 1 office computer to the hospital laboratory for order entry and to a different computer for radiology result retrieval A EHR is digitally connected to major laboratory and radiology center for results retrieval only B Digital connection between 1 office computer to the laboratory for order entry only and between 1 office computer and hospital for radiology results only C Digital connection between 1 office computer to the laboratory for order entry only D Patient communication No electronic communication with patients and no electronic generation of patient communication materials A, C, D EHR generates paper communication for patients with test results B Forcing functionsa No computer technology automatically performs or monitors results management steps A, C, D Return of results is only automatic/forced step in EHR; others (tracking, signatures, patient notification), but must be regularly performed or monitored by staff or physicians B
The Article in Brief
Management of Test Results in Family Medicine Offices
Nancy C. Elder , and colleagues
Background The management of laboratory test results in primary care offices is an important element of care quality. This study set out to determine and describe components of quality management of test results in primary care practices.
What This Study Found Among 4 family practices studied, 2 offices had written protocols or procedures; no office consistently had or followed office-wide results management practices. Most patients surveyed acknowledged receiving their test results, but fewer medical records documented patient notification, clinician response to the result, and follow-up for abnormal results. An office's level of safety awareness and appropriate adoption of technology were important factors in quality results management.
Implications
- The degree to which primary care offices are aware of safety and appropriately adopt technology are important factors in high-quality test results management and in designing systems that for higher quality of care.
- Because of the complexity of managing test results, multiple aspects of the process must be evaluated to determine quality.
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