Delivering safe and effective test-result communication, management and follow-up: a mixed-methods study protocol

Journal of the American Medical Informatics Association

et al. 2020

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Objective The management and follow-up of diagnostic test results is a major patient safety concern. The aim of this qualitative study was to explore how clinicians manage test results on an everyday basis (work-as-done) in a health information technology–enabled emergency department setting. The objectives were to identify (1) variations in work-as-done in test results management and (2) the strategies clinicians use to ensure optimal management of diagnostic test results. Materials and Methods Qualitative interviews (n = 26) and field observations were conducted across 3 Australian emergency departments. Interview data coded for results management (ie, tracking, acknowledgment, and follow-up), and artifacts, were reviewed to identify variations in descriptions of work-as-done. Thematic analysis was performed to identify common themes. Results Despite using the same test result management application, there were variations in how the system was used. We identified 5 themes relating to electronic test results management: (1) tracking test results, (2) use and understanding of system functionality, (3) visibility of result actions and acknowledgment, (4) results inbox use, and (5) challenges associated with the absence of an inbox for results notifications for advanced practice nurses. Discussion Our findings highlight that variations in work-as-done can function to overcome perceived impediments to managing test results in a HIT-enabled environment and thus identify potential risks in the process. By illuminating work-as-done, we identified strategies clinicians use to enhance test result management including paper-based manual processes, cognitive reminders, and adaptive use of electronic medical record functionality. Conclusions Test results tracking and follow-up is a priority area in need of health information technology development and training to improve team-based collaboration/communication of results follow-up and diagnostic safety.

Section: Methodsmentioning

confidence: 99%

Variation in electronic test results management and its implications for patient safety: A multisite investigation

Thomas

Journal of the American Medical Informatics Association

et al. 2020

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“…A retrospective observational study was conducted across six public hospitals in New South Wales (NSW), Australia. All study sites provide 24 hours EDs: three principal referral hospitals (EDs A, B and D) with 76 228, 54 443 and 61 348 annual ED presentations, respectively, two acute group A hospitals (ED C and ED F) with 50 025 and 38 039 annual ED presentations, respectively, and one public acute group A hospital (ED E) with 29 479 annual ED presentations (2016 data) 17…”

Section: Methodsmentioning

confidence: 99%

Timing of respiratory virus molecular testing in emergency departments and its association with patient care outcomes: a retrospective observational study across six Australian hospitals

Wabe

et al. 2019

BMJ Open

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ObjectiveA rapid molecular diagnostic test (RMDT) offers a fast and accurate detection of respiratory viruses, but its impact on the timeliness of care in the emergency department (ED) may depend on the timing of the test. The aim of the study was to determine if the timing of respiratory virus testing using a RMDT in the ED had an association with patient care outcomes.DesignRetrospective observational study.SettingLinked ED and laboratory data from six EDs in New South Wales, Australia.ParticipantsAdult patients presenting to EDs during the 2017 influenza season and tested for respiratory viruses using a RMDT. The timing of respiratory virus testing was defined as the time from a patient’s ED arrival to time of sample receipt at the hospital laboratory.Outcome measuresED length of stay (LOS), >4 hour ED LOS and having a pending RMDT result at ED disposition.ResultsA total of 2168 patients were included. The median timing of respiratory virus testing was 224 min (IQR, 133–349). Every 30 min increase in the timing of respiratory virus testing was associated with a 24.0 min increase in the median ED LOS (95% CI, 21.8–26.1; p<0.001), a 51% increase in the likelihood of staying >4 hours in ED (OR, 1.51; 95% CI, 1.41 to 1.63; p<0.001) and a 4% increase in the likelihood of having a pending RMDT result at ED disposition (OR, 1.04; 95% CI, 1.02 to 1.05; p<0.001) after adjustment for confounders.ConclusionThe timing of respiratory virus molecular testing in EDs was significantly associated with a range of outcome indicators. Results suggest the potential to maximise the benefits of RMDT by introducing an early diagnostic protocol such as triage-initiated testing.

“…One pathology laboratory provider serviced all six hospitals. The project was part of a National Health and Medical Research Council partnership project in partnership with NSW Health Pathology, and the Australian Commission on Safety and Quality in Healthcare . Ethics approval was granted by the Human Research Ethics Committee of the South Eastern Sydney Local Health District (HREC/16/POWH/412).…”

Section: Methodsmentioning

confidence: 99%

An evaluation of variation in pathology investigations and associated factors for adult patients presenting to emergency departments with chest pain: An observational study

Wabe

et al. 2018

Int J Clin Pract

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SUMMARY Objective To determine variation in pathology test ordering practices and identify associated factors for adult patients presenting to emergency departments (ED) with chest pain and subsequently admitted with ischaemic heart disease. Methods A retrospective study across six hospital EDs in New South Wales, Australia. A total of 6769 patient presentations between January 2014 and December 2017 met the inclusion criteria. Ordered pathology tests were grouped into three categories based on Australasian College for Emergency Medicine and the Royal College of Pathologists of Australasia recommendations: category I (no restriction in ordering), category II (can be ordered after consulting a supervisor) and category III (not for routine ordering in ED). The primary outcome was the proportion of category III test ordering across study EDs. Factors associated with category III test ordering were identified using a logistic regression. Results A total of 34 936 pathology tests were ordered: 65.6% (n = 22 932) were category I/II tests and 34.4% (n = 12 004) were category III tests. Five tests (Calcium Magnesium Phosphate, Coagulation Studies, Lipase, C‐reactive Protein and Blood Gas tests) accounted for 84.7% of all category III tests. The proportion of category III tests ordered varied by hospitals from 29.8% to 45.9%. The proportion of patients with at least one category III test was 76.3% (range across hospitals: 68.3%‐95.6%). Increasing age, presentation to an ED at night, and those in an imminently life‐threatening triage category were significantly associated with increased likelihood of category III test ordering. The proportion of category III tests decreased over time. EDs in medium and/or regional hospitals were more likely to order a category III test. Conclusion Pathology investigations for patients presenting with chest pain varied significantly across EDs suggesting opportunities to improve standardisation of test ordering practices.