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Tests on Day of Discharge Often Never Seen

Results of tests ordered on the day of a patient’s discharge from the hospital made up a disproportionate number of tests that doctors never review, Australian researchers found.

At a 370-bed teaching hospital, 3.1% of tests ordered during inpatient admissions were not reviewed at discharge, and 1.5% still were not reviewed 2 months after discharge, according to Enrico Coiera, MBBS, PhD, of the University of New South Wales in Sydney, and colleagues.

Although only a fraction of all tests were ordered on the day of discharge, those ordered on the last day of the hospital stay accounted for nearly half (46.8%) of tests that were not reviewed at discharge and 41.1% of those that had not been looked at by 2 months, Coiera and colleagues reported online in a research letter in Archives of Internal Medicine.

“Tests ordered as a result of poor discharge planning may well be unnecessary and are therefore strong candidates for targeted intervention,” they wrote.

The researchers looked at data on 662,858 clinical pathology tests ordered during 6,736 inpatient admissions at a single hospital. More than one-third of admissions (37.7%) had at least one test that was not reviewed before discharge, and 28% had unreviewed results 2 months post-discharge.

Test results that were still pending  –  and thus, not yet available  –  at discharge accounted for only 28.6% of the tests that were not reviewed at discharge.

Tests were significantly more likely to be reviewed at discharge if they were ordered earlier in the hospitalization. For example, 21.3% of tests ordered on the day of discharge went unreviewed before the patient left the hospital, whereas only 5.8% and 2.7% of tests available for 1 or 2 days, respectively, were not reviewed before discharge (P<0.001 for both).

Of all of the unreviewed tests, 14.7% of those at discharge and 10.8% of those 2 months later had abnormal test results. About two-thirds of all unreviewed, abnormal results came from tests ordered on the day of discharge.

“Because patients are judged ready to go home on the day of discharge, most tests ordered that day are unlikely to change care and are probably not needed,” according to Deborah Grady, MD, MPH, of the University of California San Francisco, a deputy editor of the journal.

“However,” she wrote in an editor’s note, “if an important test result is required to guide care at discharge, providers need to figure out a process to ensure follow-up.”

The authors offered some improvement strategies for discharge planning such as “clearly communicating to all members of a clinical team that discharge is being planned and instituting team rules on appropriate testing and review procedures late in admission. Discharge protocols should require review of pending or unreviewed test results,” they said.

Also, when discharge dates are known, or the average length of stay for an admission is well defined, it would be possible to estimate the time available for review, they suggested. This information can be used to trigger computer alerts when tests are being ordered electronically. “Alerts could advise clinicians either that it is unlikely that results will be posted before discharge or that the tests simply have a high risk of being missed,” they said.

Source: Todd  Neale, Senior Staff Writer, MedPage Today

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