Clinicians often fail to inform patients of their tests results— or to document that notification — raising the likelihood of a lawsuit, a recent survey suggests.
“Diagnostic errors are the most frequent cause of malpractice claims in the United States,” write researchers at Weill Cornell Medical College in New York, “and testing-related mistakes can lead to serious diagnostic errors. Failures to inform patients of abnormal results are common and legally indefensible factors in malpractice claims.”
The team reviewed medical records of 5,434 randomly selected patients in 23 primary-care practices. They found 1,889 clinically significant abnormal test results and 135 apparent failures to inform, a rate of 7.1% or about of one of every 14 tests (Arch Intern Med. 2009;169:1123-1129). That rate ranged from zero to more than one in four (26.2%), with practices that followed simple tracking procedures posting the fewest failures.
“We found that very few clinicians had explicit rules for managing test results,” said lead author Lawrence P. Casalino, MD, PhD, of the Weill Cornell Department of Public Health “In many cases, clinicians and their staff told patients that ‘no news is good news’ — meaning they should assume their tests are normal, unless they are contacted. That is a dangerous assumption.”
The study recommends these procedures to ensure patients are kept informed:
- Route all test results to the responsible clinician, who will sign off on them.
- Notify patients of all results, at least in general terms, even if the results are normal.
- Document the notification and add it to the patient’s file.
- Instruct patients to call the office, if they are not contacted within a certain amount of time.
“Failure to report abnormal test results can lead to serious, even lethal, consequences for the patient,” Dr. Casalino notes. “The good news is that clinicians who use a simple set of systematic processes to deal with test results can greatly lessen their error rates.