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Lawrence P. Casalino, MD, PhD; Daniel Dunham, MD, MPH; Marshall H. Chin, MD, MPH; Rebecca Bielang, MD; Emily O. Kistner, PhD; Theodore G. Karrison, PhD; Michael K. Ong, MD, PhD; Urmimala Sarkar, MD, MPH; Margaret A. McLaughlin, MD; David O. Meltzer, MD, PhD

Arch Intern Med. 2009;169(12):1123-1129.

Background  Failing to inform a patient of an abnormal outpatient test result can be a serious error, but little is known about the frequency of such errors or the processes for managing results that may reduce errors.

Methods  We conducted a retrospective medical record review of 5434 randomly selected patients aged 50 to 69 years in 19 community-based and 4 academic medical center primary care practices. Primary care practice physicians were surveyed about their processes for managing test results, and individual physicians were notified of apparent failures to inform and asked whether they had informed the patient. Blinded reviewers calculated a "process score" ranging from 0 to 5 for each practice using survey responses.

Results  The rate of apparent failures to inform or to document informing the patient was 7.1% (135 failures divided by 1889 abnormal results), with a range of 0% to 26.2%. The mean process score was 3.8 (range, 0.9-5.0). In mixed-effects logistic regression, higher process scores were associated with lower failure rates (odds ratio, 0.68; P < .001). Use of a "partial electronic medical record" (paper-based progress notes and electronic test results or vice versa) was associated with higher failure rates compared with not having an electronic medical record (odds ratio, 1.92; P = .03) or with having an electronic medical record that included both progress notes and test results (odds ratio, 2.37; P = .007).

Conclusions  Failures to inform patients or to document informing patients of abnormal outpatient test results are common; use of simple processes for managing results is associated with lower failure rates.

Author Affiliations: Department of Public Health, Weill Cornell Medical College, New York, New York (Dr Casalino); Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr Dunham); Sections of General Internal Medicine (Dr Chin) and Hospital Medicine (Dr Meltzer) and Department of Health Studies (Drs Kistner and Karrison), University of Chicago, Chicago; Mt Sinai Medical Center, New York (Dr Bielang); Department of Medicine, University of California, Los Angeles (Drs Ong and Sarkar); and Department of Medicine, Rush University Medical Center, Chicago (Dr McLaughlin).

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