Physician Failure to Report Abnormal Test Results to Patients

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A new study published in the journal Archives of Internal Medicine finds that, on average, physicians fail to report clinically significant abnormal test results to patients – or fail to document that they had informed them – in one out of every fourteen cases [1]. In some practices, the failure-to-inform rate is as high as one in five abnormal results.

Researchers at Cornell University’s Weill Cornell Medical College analyzed 5,434 patient records from 23 physician practices across the country, selecting 11 blood tests and 3 screening tests (mammography, Papanicolaou smear and fecal occult blood) commonly performed in the outpatient setting. They consulted with physicians in the appropriate specialties to define a range of clinically significantly abnormal values for each test. For each abnormal result then identified, the scientists searched the patient’s medical record for 13 types of events that occurred in most cases within 90 days suggesting that the patient had been informed. These events included a note stating that the patient had been informed, a repeat of the abnormal test or if a consultation or procedure was performed.

The scientists found the average rate of failure to inform or document was 7.1% (135 failures from 1,889 abnormal test results). Failure rates ranged from 0% in three small practices (with less than 9 primary care MDs) to greater than 20% in two academic medical centers (with more than 32 primary care MDs). Based on a literature review and a pilot study that the researchers conducted, they define five “good processes” for managing test results:

1. All test results are routed to the responsible physician.
2. The physician signs off on all results.
3. The practice informs patients of all results, normal and abnormal, at least in general terms.
4. The practice documents that the patient has been informed.
5. Patients are told to call after a certain time interval if they have not been notified of their results.

The researchers found that medical groups using more of the five “good processes” to manage test results had lower rates of failure than groups that did not. Most practices evaluated did not use all five processes.

The study also found that medical groups using electronic medical records (EMRs) did not compensate for the lack of procedure to follow-up with patients. Failure-to-inform rates were relatively low in practices with good processes, regardless of whether they had a full EMR. Practices that used a combination of paper and electronic records – a “partial EMR” – had the highest failure-to-inform rates.

The study was led by Dr. Lawrence P. Casalino, chief of the Division of Outcomes and Effectiveness Research in the Department of Public Health of Weill Cornell Medical College. According to Dr. Casalino [2]:

We found that very few physician practices had explicit rules for managing test results. In many practices, each physician devised his or her own method. And in many cases, physicians and their staff told patients that ‘no news is good news’ – meaning they should assume that their tests are normal unless they are contacted. This is a dangerous assumption.

This study has several limitations. Failure-to-inform was based on the lack of evidence of any one of 13 events that would suggest the patient was informed. However, it is possible that in some of the cases counted as failures to inform, the patient actually was informed. Further, each of the practices included in the study agreed to participate and a random sampling a practices may reflect different failure-to-inform rates. Lastly, only a limited number of primary care physician practices were studied on the West Coast and in the Midwest.

The take-home message? Follow up with your physician to find out about test results, even if it means calling yourself. Never assume ‘no news is good news’.

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References

1. Casalino et al. Frequency of failure to inform patients of clinically significant outpatient test results. Arch Intern Med. 2009 Jun 22;169(12):1123-9. DOI: 10.1001/archinternmed.2009.130
   View abstract
2. Physicians Frequently Fail to Inform Patients About Abnormal Test Results. Weill Cornell News. 2009 Jun 22.