Improving test result communication, management and follow up

Background and aims

Background

Medicare-funded pathology and medical imaging services cost the Australian community $5.25 billion in 2013, an increase of 81% for pathology and 116% for medical imaging over the preceding decade. This increased volume of clinical information has contributed to the increased complexity of patient care delivery and raised concerns about the costs and risks associated with unnecessary repeat tests. In many instances increased test volume has also resulted in a lack of clarity about where, and with whom responsibility for test result follow-up should reside. Many doctors describe existing test result management systems as inefficient and chaotic. It is not surprising therefore, that one in four diagnosis-related malpractice suits in medical imaging in the United States (US), includes problems with test result follow-up. A 2012 study of tests ordered in a Sydney hospital revealed that 47% of missed test results emanated from tests ordered on the day of patient discharge, raising important questions about the necessity and appropriateness of tests which are ordered but whose results are never reviewed.

Aims

This NHMRC Partnership Project aims to establish safe, effective and sustainable test result management systems utilising evidence-based practice, health IT and consumer engagement. The research will be undertaken across six hospitals in the South Eastern Sydney and Illawarra Shoalhaven Local Health Districts and the Sydney Children’s Hospital, and will make a significant contribution to enhanced patient safety in Australia and internationally. It will achieve this by undertaking three studies that:

• improve the effectiveness and safety of test result management through the establishment of clear governance processes of communication, responsibility and accountability;
• harness health IT to inform and monitor test result management; and
• enhance the contribution of consumers to the establishment of safe and effective test result management systems.

Design and method

Study 1: Improve the effectiveness and safety of test result management through the establishment of clear processes of communication, responsibility and accountability.

Study 1 will be carried out across three stages designed to map current test management practices within our study sites and to identify “evidence-practice gaps” which pose patient safety risks.

• Stage 1: Mapping of test management practices to outline current levels of communication, responsibility and accountability
• Stage 2: Development of an organisational test result management clinical governance framework and the identification and implementation of test result follow-up interventions
• Stage 3: Implementation of improved test management governance processes

Study 2: Harness health IT to inform and monitor test result management.

Study 2 is comprised of two components:

• A data-driven approach to inform the adoption of critical test result thresholds and notification processes
• Controlled before and after study across three Emergency Departments

Study 3: Enhance the contribution of consumers to the establishment of safe and effective test result management systems.

This study will involve the establishment of a Consumer Reference Group (CRG) to enhance the contribution of consumers to safe test result management, including through the provision of test results to patients.

News and media

• 18 May 2018: Vale Betty Johnson AO
• 26 February 2016: The Royal College of Pathologists of Australasia (RCPA) issues a media release entitled “Five year study has commenced to improve medical test reporting” in the lead up to the College’s annual conference 26-28 February 2016. Pulse+IT runs an electronic article, “Study to build evidence base for improved pathology test reporting” by Kate McDonald, 2 March 2016. http://www.pulseitmagazine.com.au/australian-ehealth/2944-study-to-build-evidence-base-for-improved-pathology-test-reporting?utm_source=Pulse%2BIT
• March 2016: Royal College of Pathologists of Australasia (RCPA) ePathWay article - World-leading study will look at ways to improve medical test reporting
• April 2016: Health Consumers NSW news item
• May 2016:  An alliance to achieve safer health test results
• May 2016:  Pulse IT: Study kicks off into how IT can improve test result follow-up

Publications

• Dahm MR, Li J, Georgiou A. Consumer contribution to safe and quality test result management. Paper presented at the Australian Institute of Health Innovation Consumer Symposium 2017. Consumers and Researchers Partnering for the Future, 17 March 2017, Sydney.
• Georgiou A. How should we deal with missed test results and pending results at discharge? Invited presentation Pathology Update 2016 Melbourne 27 February 2016. Pathology Vol 48 Supplement 1
• Dahm MR, Greenfield D, Brown A, Malalasekera P, Callen J, Georgiou A. (Forthcoming). Enhancing consumer engagement in the test result management process to build safe and quality person-centred pathology and medical imaging practice. Paper presented at the 2016 HIMAA NCCH National Conference, 8-10 November 2016, Melbourne.
• Greenfield D, Lindeman R, Malalasekera P, Georgiou A. Delivering safe and effective test result communication, management and follow up: an Australian research study [Poster]. 33^rd International Safety and Quality Conference: Change and stability in healthcare quality: the future challenges, International Society for Quality in Health Care, Tokyo, Japan, 16-19 October 2016.
• Dahm MR, Georgiou A, Westbrook JI, Greenfield D, Horvath AR, Wakefield D, Li L, Hillman K, Bolton P, Brown A, Jones G. Delivering safe and effective test-result communication, management and follow-up: a mixed-methods study protocol. BMJ open. 2018 Feb 1;8(2):e020235. http://bmjopen.bmj.com/content/8/2/e020235
• Dahm MR, Li J, Thomas J, Georgiou A. Exploring Human factors and health information technology in test result management. Paper presented at the Human Factors and Ergonomics Society of Australia (HFESA) Conference 2017, November 26 -29, Wollongong 2017.
• Kuziemsky C, Georgiou A, Li J, Dahm MR. Understanding the collaboration space of diagnostic errors. Paper presented at the 1st Australasian Diagnostic Medical Error conference May 24-25, Melbourne. 2017
• Dahm MR, Brown A, Li J, Westbrook JI, Georgiou A. Employing consumer engagement strategies to enhance the safety and effectiveness of health information technology in test result management. Poster presented at the 1st Australasian Diagnostic Medical Error conference May 24-25, Melbourne. 2017.
• Thomas J, Li J, Dahm M, Westbrook JI, Georgiou A. A qualitative investigation of workflows in the processing and communication of pathology laboratory results. Poster presented at the 1st Australasian Diagnostic Medical Error conference May 24-25, Melbourne. 2017
• Li J, Thomas J, Dahm M, Westbrook JI, Georgiou A. How does health information technology impact on the safety of test result follow-up? Findings from a systematic review. Poster presented at the 1st Australasian Diagnostic Medical Error conference May 24-25, Melbourne. 2017
• Dahm MR, Brown A, Malalasekera P, Lindeman R, Georgiou A. Personal patient preferences – Shaping research on management of pathology and imaging test results through consumer engagement.  Paper presented at the 2017 NSW Patient Experience Symposium Sydney, 1 – 2 May 2017.

Resources

NHMRC Partnership Pathology - Stakeholder forum report