Timely follow-up of abnormal outpatient test results: Perceived barriers and impact on patient safety

PURPOSE: To assess internal medicine physicians' perceptions regarding delays in the follow up of ambulatory test results and the clinical consequences of delays. METHODS:: Anonymous survey of internal medicine physicians at 3 large academic medical centers. The survey asked about physician practices regarding follow up of commonly ordered ambulatory test results, major barriers to follow-up, and perception of harm due to delayed follow-up. RESULTS:: One hundred ninety-five (66%) of 297 eligible physicians completed the survey. House staff physicians were more likely to take 1 or more weeks to review the results of tests sent on their ambulatory patients. Forty-six percent of house staff physicians took 1 or more weeks to review laboratory results compared with only 8% of attending physicians (P < 0.001), and 58.7% of house staff physicians took 1 or more weeks to review radiographic study results compared with 24.5% of attending physicians (P < 0.001). The most common barrier to timely follow up was the lack of a reminder system. Overall, at least a few times per year, 70.4% of respondents reported seeing patients with delays in diagnosis or treatment because of delays in test result follow-up, and 40.4% reported seeing patients with worsening medical conditions because of delays in follow-up. CONCLUSIONS:: Physicians perceive that the lack of timely follow up of abnormal test results is common in the ambulatory setting and that patients are harmed as a result. Interventions such as automatic reminders and changes in house staff workflow are needed to ensure that abnormal test results are followed up in a timely manner.