Timely Follow-up of Abnormal Diagnostic Imaging Test Results in an Outpatient Setting Are Electronic Medical Records Achieving Their Potential?
Timely Follow-up of Abnormal Diagnostic Imaging Test Results in an Outpatient Setting Are Electronic Medical Records Achieving Their Potential?
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DOI：
10.1001/archinternmed.2009.263
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发表时间：
2009-09-28
影响因子：
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通讯作者：
Petersen, Laura A.
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文献类型：
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作者：
Singh, Hardeep;Thomas, Eric J.;Petersen, Laura A.
背景：鉴于门诊治疗的分散性，及时随访异常诊断影像学结果仍然是一个挑战。我们假设，一个电子病历（EMR），促进传输和重要的成像结果的可用性，通过自动通知（警报）或直接访问的主要report.Methods将消除这个问题：我们研究了关键的成像警报通知在门诊设置的三级护理部退伍军人事务部的设施，从2007年11月至2008年6月。跟踪软件确定警报是否在传输后2周内得到确认（即，医疗保健从业者/提供者[HCP]打开消息进行查看）;确认的警报被视为已读。我们审查了医疗记录并联系了HCP，以确定在传播后4周内及时采取的随访措施（例如，安排随访检查或咨询）。多变量逻辑回归模型的聚类效应由HCP分析预测因子为2个结局：缺乏承认和缺乏及时follow-up.Results：123 638研究（包括X线片，计算机断层扫描，超声，磁共振图像，和乳房X线片），1196图像（0.97%）产生警报，其中217（18.1%）是未确认。当发出命令的HCP是培训生时（比值比[ OR]，5.58; 95%置信区间[CI]，2.86-10.89），以及当使用双重警报（>1个HCP警报）而不是单一警报通信时（OR，2.02; 95% CI，1.22-3.36），警报未被确认的风险更高。92例（占所有警报的7.7%）缺乏及时随访，确认和未确认警报的情况相似（7.3% vs 9.7%; P = 0.22）。使用双重警报沟通时，缺乏及时随访的风险较高（OR，1.99; 95%CI，1.06-3.48），但放射科医生使用额外的口头沟通时，缺乏及时随访的风险较低（OR，0.12; 95%CI，0.04-0.38）。几乎所有的异常结果缺乏及时的后续行动，在4周最终发现有可衡量的临床影响，在进一步的诊断检测或treatment.Conclusions：关键的成像结果可能不会得到及时的后续行动，即使当HCP接收和读取结果在一个先进的，集成的电子病历系统。需要多学科方法来提高这一领域的患者安全性。
Background: Given the fragmentation of outpatient care, timely follow-up of abnormal diagnostic imaging results remains a challenge. We hypothesized that an electronic medical record (EMR) that facilitates the transmission and availability of critical imaging results through either automated notification (alerting) or direct access to the primary report would eliminate this problem.Methods: We studied critical imaging alert notifications in the outpatient setting of a tertiary care Department of Veterans Affairs facility from November 2007 to June 2008. Tracking software determined whether the alert was acknowledged (ie, health care practitioner/provider [HCP] opened the message for viewing) within 2 weeks of transmission; acknowledged alerts were considered read. We reviewed medical records and contacted HCPs to determine timely follow-up actions (eg, ordering a follow-up test or consultation) within 4 weeks of transmission. Multivariable logistic regression models accounting for clustering effect by HCPs analyzed predictors for 2 outcomes: lack of acknowledgment and lack of timely follow-up.Results: Of 123 638 studies (including radiographs, computed tomographic scans, ultrasonograms, magnetic resonance images, and mammograms), 1196 images (0.97%) generated alerts; 217 (18.1%) of these were unacknowledged. Alerts had a higher risk of being unacknowledged when the ordering HCPs were trainees (odds ratio [ OR], 5.58; 95% confidence interval [CI], 2.86-10.89) and when dual-alert (>1 HCP alerted) as opposed to single-alert communication was used (OR, 2.02; 95% CI, 1.22-3.36). Timely follow-up was lacking in 92 (7.7% of all alerts) and was similar for acknowledged and unacknowledged alerts (7.3% vs 9.7%; P = .22). Risk for lack of timely follow-up was higher with dual-alert communication (OR, 1.99; 95% CI, 1.06-3.48) but lower when additional verbal communication was used by the radiologist (OR, 0.12; 95% CI, 0.04-0.38). Nearly all abnormal results lacking timely follow-up at 4 weeks were eventually found to have measurable clinical impact in terms of further diagnostic testing or treatment.Conclusions: Critical imaging results may not receive timely follow-up actions even when HCPs receive and read results in an advanced, integrated electronic medical record system. A multidisciplinary approach is needed to improve patient safety in this area.