BackgroundResults of some laboratory tests for Emergency Department (ED) patients return hours to days after the patient is discharged. Inadequate follow-up for these late-arriving results poses medical and legal risks. We have developed, but not yet implemented, a computerized system called the Automated Late-Arriving Results Monitoring System (ALARMS). ALARMS scans the hospitalrsquo;s laboratory and ED registration databases to generate an electronic daily log of all late-arriving abnormal laboratory results for ED patients.ObjectiveTo determine the potential impact of ALARMS by assessing our EDrsquo;s current quality of documented follow-up of late-arriving laboratory results.MethodsWe applied ALARMS retrospectively, to find all abnormal late-arriving laboratory results returned between 5/1/96 and 4/30/98 for ED patients for the following three testscolon; serum lead levels, Chlamydia cultures, or urine pregnancy tests. Medical records were reviewed for documentation of follow-up, which was considered appropriate if a clinician noted the abnormal result and documented a follow-up plan within 1 week after the result became available. Medical records were also reviewed for any evidence of complications attributable to delayed or inadequate follow-up.ResultsOver the 2-year study period, no appropriate follow-up was documented in 6/18 (33percnt;) cases of elevated lead levels, 3/4 (75percnt;) cases of late-arriving positive pregnancy tests, and 23/39 (59percnt;) cases of positive Chlamydia cultures. One case of a positive Chlamydia culture, for which there was no documented follow-up, was associated with subsequent development of pelvic inflammatory disease.ConclusionOur current system of documented follow-up for late-arriving laboratory results has deficiencies. ALARMS, a computerized system of alerts for emergency physicians, has the potential to substantially improve documented follow-up of late-arriving laboratory results in the ED.
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