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Dissatisfaction With Test Result Management Systems in Primary Care

Eric G. Poon, MD, MPH; Tejal K. Gandhi, MD, MPH; Thomas D. Sequist, MD; Harvey J. Murff, MD, MPH; Andrew S. Karson, MD, MPH; David W. Bates, MD, MSc

Arch Intern Med. 2004;164:2223-2228.

Background  Failure to review and follow up on outpatient test results in a timely manner represents a patient safety and malpractice concern. Therefore, we sought to identify problems in current test result management systems and possible ways to improve these systems.

Methods  We surveyed 262 physicians working in 15 internal medicine practices affiliated with 2 large urban teaching hospitals (response rate, 64%). We asked physicians about systems they used and the amount of time they spent managing test results. We asked them to report delays in reviewing test results and their overall satisfaction with their management of test results. We also asked physicians to rate features they would find useful in a new test result management system.

Results  Overall, 83% of respondents reported at least 1 delay in reviewing test results during the previous 2 months. Despite reporting that they spent on average 74 minutes per clinical day managing test results, only 41% of physicians reported being satisfied with how they managed test results. Satisfaction was associated with fewer self-reported delays in reviewing test results. Physicians who actively tracked their test orders to completion were also more likely to be satisfied. The most highly desired features of a test result management system were tools to help physicians generate result letters to patients, prioritize their workflow, and track test orders to completion.

Conclusions  Delays in test result review are common, and many physicians are not satisfied with how they manage test results. Tools to improve test result management in office practices need to improve workflow efficiency and track test orders to completion.

Author Affiliations: Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Mass (Drs Poon, Gandhi, Sequist, and Bates); Nashville VA Medical Center, Nashville, Tenn (Dr Murff); and Massachusetts General Hospital, Boston (Dr Karson).

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