Diagnostic errors are among the most common underlying causes of New York City medical malpractice. It is self-evident that medical professionals must make reasonable decisions about ordering tests, must diligently read the results, and must make fair assessments of the next steps required based on those results. However, a new research effort suggests that some facilities might have systematic problems with these testing issues. Specifically, the study showed that medical tests completed just prior to patient hospital discharge are often never read or acted upon.
The report, published in Archives of Internal Medicine earlier this month, looked at more than 660,000 tests ordered for more than 6,700 patients at a single metropolitan hospital.
The lead author of this study noted, “We know that many tests that are ordered in hospitals never get looked at, yet these tests carry as much important information about patient health as other tests.” The study’s goal was to look at why doctors go to the trouble of ordering tests they never look at.
The research found that close to one half of all tests ordered on the day a patient is discharged are never looked at.
“Some of these are unnecessary and represent a major opportunity to save on costs,” the lead author summarized. “Others are clinically significant, and should be followed up.”
Specifically, although discharge-day tests account for only seven percent of tests ordered, they account for 47 percent of unread tests at the time of discharge and 41 percent of unread tests two months after discharge.
This failure to read and follow up on test results presents a risk to patient health, as the test results could contain important or even life-saving information that medical professionals ignore.
Those familiar with the problem note several ideas of how to solve or minimize the issue. One obvious solution is keeping records matching patient discharges to tests and warning hospital staff that the patient has left. Electronic medical records may prove crucial, with the potential to automatically remind doctors to look at test results. As it is, patients often fall through the cracks when they leave or are moved. It becomes more complicated after the patient is discharged to know who is responsible for reviewing the tests. Another study author, a professor of medicine at Harvard, agreed that electronic records could be a solution and added that alerts could be sent directly to the patient’s’ primary care doctor.
A more traditional solution is better planning–having the discharge procedure begin earlier to allow for more time before the patient actually walks out the door. Patients themselves can also be proactive, calling the hospital or their doctor to follow up on any remaining test results.
As a New York medical malpractice lawyer, I understand the significant problem uprooted by this research. Test results should be ordered when necessary and the results always examined. Deviating from this common-sense principle is inefficient and dangerous.
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