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Docs Don't Tell 7% of Patients About Abnormal Tests

Cheryl Clark, for HealthLeaders Media, June 23, 2009

When patients' test results are abnormal, their doctors failed to tell them the bad news more than 7% of the time, and in practices that used a combination of paper and electronic medical records, the failure rate was as high as 26%, according to a new report.

Some patients were given a false sense of security in that they were told if they didn't hear anything, the test result was fine. Some patients were told, "No news is good news."

"Failures to inform patients of clinically significant abnormal test results or to document that they have been informed appear to be relatively common, occurring in 1 of every 14 tests," the researchers wrote.

The study, by Lawrence Casalino, MD, of the Weill Cornell Medical College in New York, and colleagues in Chicago and Los Angeles, was published in the Archives of Internal Medicine yesterday. The researchers said theirs is the first to document a failure rate for a broad set of tests for a large and varied group of physician practices.

Medical records from 5,434 patients between the ages of 50 to 69 were examined from the files of nearly 200 volunteering primary care physicians in PPOs in the West and Midwest. The researchers discovered 1,889 abnormal results, but 135 of those findings were never conveyed to the patients.

The project selected only patients who had undergone any of 11 blood tests, such as cholesterol or hemoglobin, or three screening tests, such as mammography, Pap smear, or fecal occult blood. A failure to notify the patient was counted when the abnormal result was deemed clinically significant, in that the outcome could have indicated a lethal disease process.

For example, patients were not informed of results of total cholesterol levels as high as 318 mg/dL, a hemoglobin A1c as high as 18.9%, a potassium level as low as 2.6 mEq/L, or a hematocrit level as low as 28.6%.

The patient was said to not have been informed if there was no record of the patient being told, no follow-up referral, or any other documentation indicating disclosure within 90 days of the date the physician received the test result. In the case of high or low sodium or potassium level tests, the interval was 21 days.

Perhaps a surprising result from the study was that when an electronic medical record system was used in combination with a paper record system, it made the process worse. In the four practices that used both, the failure rate was 5.4%, 8.7%, 21.5%, and 26.2% (the last two were the worst scores in the study). Practices that used only paper records were almost as good as practices that had transitioned completely to an electronic medical record system.

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