Introduction: Communicating Critical Test Results

摘要

Fifteen years ago, the three supervising physicians of our Monday general medicine clinic (GMC) came to work on Sunday nights. We were interested in learning how well we did following up on abnormal test results. Although the patients weren't there, their charts were. During the course of the next month, we reviewed hundreds of medical records looking for what we defined as "action-requiring abnormal results"—laboratory tests and x-rays that were abnormal and reasonably required some follow-up action (for example, starting or stopping a drug, referral for a potentially malignant condition, or, at the very least, repeating the test some time in the future). What we found was alarming. One out of every five charts contained one (or more) "action-requiring" abnormal test result with no documented acknowledgment, action, or follow-up. Risk managers might say that the basket of charts we sampled was loaded with ticking time bombs, ready to ignite a malpractice suit for any adverse event that a plaintiffs attorney could plausibly connect to the abnormal lab. We, of course, worried about the patients. When we found a number of positive syphilis serology tests that had not been addressed, we grimly wondered whether we had uncovered "Tuskeegee in the GMC."