Using Computerized Provider Order Entry to Enforce Documentation of Tests with Pending Results at Hospital Discharge

Summary

Background: Small numbers of tests with pending results are documented in hospital discharge summaries leading to breakdown in communication and medical errors due to inadequate followup.

Objective: Evaluate effect of using a computerized provider order entry (CPOE) system to enforce documentation of tests with pending results into hospital discharge summaries.

Methods: We assessed the percent of all tests with pending results and those with actionable results that were documented before (n = 182 discharges) and after (n = 203 discharges) implementing the CPOE-enforcement tool. We also surveyed providers (n = 52) about the enforcement functionality.

Results: Documentation of all tests with pending results improved from 12% (87/701 tests) before to 22% (178/812 tests) (p = 0.02) after implementation. Documentation of tests with eventual actionable results increased from 0% (0/24) to 50% (14/28)(p<0.001). Survey respondents felt the intervention improved quality of summaries, provider communication, and was not time-consuming. Conclusions: A CPOE tool enforcing documentation of tests with pending results into discharge summaries significantly increased documentation rates, especially of actionable tests. However, gaps in documentation still exist.

Keywords

Patient Discharge - Routine Diagnostic Tests - Medical Order Entry Systems - Documentation - Medical Errors

• References

• 1 Roy CL. et al. Patient safety concerns arising from test results that return after hospital discharge. Ann Intern Med 2005; 143: 121-128.
• 2 Moore C, Wisnivesky J, Williams S, McGinn T. Medical errors related to discontinuity of care from an in-patient to an outpatient setting. J Gen Intern Med 2003; 18: 646-651.
• 3 Hickner JM. et al. Issues and initiatives in the testing process in primary care physician offices. Jt Comm J Qual Patient Saf 2005; 31: 81-89.
• 4 Myers KA, Keely EJ, Dojeiji S, Norman GR. Development of a rating scale to evaluate written communication skills of residents. Academic Medicine 1999; 74: S111.
• 5 Sanders PS. System failures: a malpractice pitfall. MMIE Risk Management Committee. Minn Med 1987; 70: 708-709.
• 6 Birenbaum R. Who is responsible if a patient is not told of negative lab results?. CMAJ 1989; 141: 970-972.
• 7 Henry PF. Abnormal laboratory test results: going the extra mile. Nurse Pract Forum 1991; 2: 5-7.
• 8 Lawrence J. Do you always make sure patients get test results?. Manag Care 1996; 5: 37-41.
• 9 Kripalani S. et al. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA 2007; 297: 831-841.
• 10 Were MC. et al. Adequacy of hospital discharge summaries in documenting tests with pending results and outpatient follow-up providers. J Gen Intern Med 2009; 24: 1002-1006.
• 11 Halasyamani L. et al. Transition of care for hospitalized elderly patients –development of a discharge checklist for hospitalists. J Hosp Med 2006; 1: 354-360.
• 12 Snow V. et al. Transitions of Care Consensus policy statement: American College of Physicians, Society of General Internal Medicine, Society of Hospital Medicine, American Geriatrics Society, American College Of Emergency Physicians, and Society for Academic Emergency Medicine. J Hosp Med 2009; 4: 364-370.
• 13 Dalal AK. et al. Lessons learned from implementation of a computerized application for pending tests at hospital discharge. Journal of Hospital Medicine 2011; 6 (01) 16-21.
• 14 Bates DW. Getting in Step: Electronic health records and their role in care coordination. J Gen Intern Med 2010; 2010 25 (03) 174-176.
• 15 McDonald CJ. et al. The Regenstrief Medical Record System: a quarter century experience. Int J Med Inform 1999; 54: 225-253.