Notification of Abnormal Lab Test Results in an Electronic Medical Record: Do Any Safety Concerns Remain?
Notification of Abnormal Lab Test Results in an Electronic Medical Record: Do Any Safety Concerns Remain?
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DOI：
10.1016/j.amjmed.2009.07.027
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发表时间：
2010-03-01
影响因子：
5.9
通讯作者：
Petersen, Laura A.
中科院分区：
文献类型：
--
作者：
Singh, Hardeep;Thomas, Eric J.;Petersen, Laura A.
背景：门诊实验室检查结果异常的随访是一个主要的患者安全问题。电子医疗记录可以通过自动通知解决这一问题。我们研究了在集成电子病历中自动通知异常实验室结果（警报）是否会导致及时的后续actions.METHODS：我们研究了4个警报：血红蛋白Alc >= 15%，丙型肝炎抗体阳性，前列腺特异性抗原>= 15 ng/mL和促甲状腺激素>= 15 mIU/L。警报跟踪系统确定警报是否在传输后2周内得到确认（即，提供者点击并打开消息）;确认的警报被视为已读。在结果传输后30天内，记录审查和提供者联系确定了后续行动（例如，患者接触、治疗）。多变量逻辑回归模型分析预测缺乏及时follow-up.RESULTS：在2008年5月至12月，78,158测试（血红蛋白Ale，丙型肝炎抗体，促甲状腺激素，前列腺特异性抗原）进行，其中1163（1.48%）作为警报传输，其中10.2%（119/1163）是未确认的。79例（6.8%）患者缺乏及时随访，确认和未确认警报的差异无统计学意义（6.4% vs 10.1%; P = 0.13）。在1163个警报中，有202个（17.4%）是由不必要的有序（冗余）测试引起的。与已知诊断相比，新诊断的警报更可能缺乏及时的随访（比值比7.35; 95%置信区间，4.16-12.97），而与冗余检测相关的警报不太可能缺乏及时随访（比值比0.24; 95%可信区间，0.07-0.84）。尽管在门诊环境中自动通知非危及生命的异常实验室结果，但与及时患者随访相关的安全性问题仍然存在，由Elsevier Inc. .美国医学杂志（2010）123，238-244
BACKGROUND: Follow-up of abnormal outpatient laboratory test results is a major patient safety concern. Electronic medical records can potentially address this concern through automated notification. We examined whether automated notifications of abnormal laboratory results (alerts) in an integrated electronic medical record resulted in timely follow-up actions.METHODS: We studied 4 alerts: hemoglobin Alc >= 15%, positive hepatitis C antibody, prostate-specific antigen >= 15 ng/mL and thyroid-stimulating hormone >= 15 mlU/L. An alert tracking system determined whether the alert was acknowledged (ie, provider clicked on and opened the message) within 2 weeks of transmission;. acknowledged alerts were considered read. Within 30 days of result transmission, record review and provider contact determined follow-up actions (eg. patient contact, treatment). Multivariable logistic regression models analyzed predictors for lack of timely follow-up.RESULTS: Between May and December 2008, 78,158 tests (hemoglobin Ale, hepatitis C antibody, thyroid- stimulating hormone, and prostate-specific antigen) were performed, of which 1163 (1.48%) were transmitted as alerts; 10.2% of these (119/1163) were unacknowledged. Timely follow-up was lacking in 79 (6.8%), and was statistically not different for acknowledged and unacknowledged alerts (6.4% vs 10.1 %; P = .13). Of 1163 alerts, 202 (17.4%) arose from unnecessarily ordered (redundant) tests. Alerts for a new versus known diagnosis were more likely to lack timely follow-up (odds ratio 7.35; 95% confidence interval, 4.16-12.97), whereas alerts related to redundant tests were less likely to lack timely follow-up (odds ratio 0.24; 95% confidence interval, 0.07-0.84).CONCLUSIONS: Safety concerns related to timely patient follow-up remain despite automated notification of non-life-threatening abnormal laboratory results in the outpatient setting, Published by, Elsevier Inc. . The American Journal of Medicine (2010) 123, 238-244