Test Result Management Practices of Canadian Internal Medicine Physicians and Trainees

Abstract

Background: Missed test results are a cause of medical error. Few studies have explored test result management in the inpatient setting. Objective: To examine test result management practices of general internal medicine providers in the inpatient setting, examine satisfaction with practices, and quantify self-reported delays in result follow-up. Design: Cross-sectional survey. Participants: General internal medicine attending physicians and trainees (residents and medical students) at three Canadian teaching hospitals. Main Measures: Methods used to track test results; satisfaction with these methods; personal encounters with results respondents “wish they had known about sooner.” Key Results: We received surveys from 33/51 attendings and 99/108 trainees (response rate 83%). Only 40.9% of respondents kept a record of all tests they order, and 50.0% had a system to ensure ordered tests were completed. Methods for tracking test results included typed team sign-out lists (40.7%), electronic health record (EHR) functionality (e.g., the electronic “inbox”) (38.9%), and personal written or typed lists (14.8%). Almost all trainees (97.9%) and attendings (81.2%) reported encountering at least one test result they “wish they had known about sooner” in the past 2 months (p = 0.001). A higher percentage of attendings kept a record of tests pending at hospital discharge compared to trainees (75.0% vs. 35.7%, p < 0.001), used EHR functionality to track tests (71.4% vs. 27.5%, p = 0.004), and reported higher satisfaction with result management (42.4% vs. 12.1% satisfied or very satisfied, p < 0.001). Conclusions: Canadian physicians report an array of problems managing test results in the inpatient setting. In the context of prior studies from the outpatient setting, our study suggests a need to develop interventions to prevent missed results and avoid potential patient harms.