Crossing the Finish Line: Follow-up of Abnormal Test Results in a Multisite Community Health Center
Crossing the Finish Line: Follow-up of Abnormal Test Results in a Multisite Community Health Center
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DOI：
10.1016/s0027-9684(15)30658-1
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发表时间：
2010-08-01
影响因子：
3.3
通讯作者：
Hickner, John
中科院分区：
文献类型：
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作者：
Chen, Eric T.;Eder, Mickey;Hickner, John
背景：对异常检查结果随访不足是门诊实践中常见的安全问题。然而，目前尚不清楚在结果管理过程中失败发生的确切位置和频率。我们的目标是通过检查城市社区卫生中心组织的11个诊所的4个高风险异常测试结果来确定故障发生的位置。方法：采用图表审计，我们统计了4项检查异常结果管理的失败：巴氏涂片检查、乳房x光检查、国际标准化比率（INR）和前列腺特异性抗原（PSA）。我们评估了结果在图表中归档的文件；提供者签名并响应结果，患者被告知结果；适当的随访发生，并且及时发生或有明确的患者拒绝推荐的随访。结果：异常检查结果344例（巴氏涂片105例，x光82例，INRs 61例，psa 96例）。管理过程中失败率最高的是随访护理；34%的异常结果没有适当随访的记录（乳房x光检查为11%，INR检查为26%，巴氏涂片检查为45%，PSA检查为46%）。所有前面的步骤都以更少的失败执行。在接受随访治疗的患者中，有49%的患者没有及时得到随访治疗。结论：在这4项异常检查的检测过程中，大多数故障发生在最后一步，记录了适当的随访护理。需要管理异常结果报告和患者随访的办公室系统，以提高护理的安全性和质量。
Background: Inadequate follow-up of abnormal test results is a common safety problem in outpatient practice. However, it is unclear exactly where and how often failures occur in the results management process. Our goal was to determine where breakdowns occur by examining 4 high-risk abnormal test results in a group of 11 clinics of an urban community health center organization.Methods: Using a chart audit, we counted failures in the management of abnormal results of 4 tests: Pap smears, mammograms, international normalized ratio (INR), and prostate-specific antigen (PSA). We assessed documentation that the result was filed in the chart; the provider signed and responded to the result the patient was notified of the result; the appropriate follow-up occurred, and it occurred in a timely manner or there was explicit patient refusal of the recommended follow-up.Results: There were 344 abnormal test results (105 Pap smears, 82 mammograms, 61 INRs, and 96 PSAs). The highest rate of failures in the management process was at follow-up care; 34% of the abnormal results did not have documentation that appropriate follow-up had occurred (11% for mammography, 26% for INR, 45% for Pap smears, and 46% for PSA). All of the earlier steps were performed with far fewer failures. For patients receiving follow-up care, 49% of the time, follow-up care did not occur in a timely manner.Conclusions: Most breakdowns in the testing process for these 4 abnormal tests were in the final step, documenting that appropriate follow-up care occurred. Office systems for managing abnormal results reporting and patient follow-up are needed to improve the safety and quality of care.