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Subcritical Test Result Management

The Problem

Delays in receiving or acting on test results in outpatient settings often lead to missed diagnoses, are leading causes of closed malpractice claims, and contribute significantly to morbidity and mortality. Primary care clinicians cite missing clinical information as a significant source of medical error. While Joint Commission National Patient Safety Goals focus on policies and procedures for critical results, greater variability exists in the management of subcritical abnormal results, which often require no urgent clinical action, but are harmful and even fatal when not followed up on.

While electronic health records (EHRs) are often cited as a test results management solution, even practices with comprehensive EHRs - which most ambulatory settings do not - have significant diagnostic delays, especially when they receive test results through faxes or scans from external systems rather than via electronically linked and actionable data. Safety net health care systems are at particular risk for delays in acting on subcritical test results due to piecemeal EHR adoption, workforce staffing and turnover, and an already vulnerable patient population with low health literacy, limited English proficiency, and competing demands to secure basic needs. Therefore, reducing delays in acting on subcritical test results in the safety net will require deep system-level engagement, intensive and effective stakeholder involvement, and innovative socio-technical solutions.

Our Proposed Solution

The overall goal of this project is to develop a system-wide new practice for ensuring reliable, consistent, and timely identification of sub-critical test results with accurate routing to the correct provider, followed by clear documentation of follow-up. We strive to achieve timely, accurate, and active test result management in the San Francisco Health Network via the following aims:

  1. Engage stakeholders across the integrated safety net health care system to identify the most concerning set of subcritical abnormal laboratory and radiology results, current gaps in communication of these results to responsible clinicians, and current gaps in tracking clinical actions to follow-up these results.
  2. Design and develop a health information technology (HIT) solution to allow for timely, trackable subcritical test result management.
  3. Pilot the technical solution at two sites and iterate upon it based on feasibility, usability, and workflow considerations.
  4. Implement the iterated, workflow-integrated technical solution at an evaluation site and conduct qualitative and quantitative evaluation to determine effectiveness in reducing delays in clinical action using an implementation science framework.