Tests on Day of Discharge Are Often Never Seen

The 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 reviewed, according to a new study.

Researchers at the Australian Institute of Health Innovations (Sydney, Australia), and St Vincent's Hospital (Sydney, Australia) reviewed data on 662,858 clinical pathology tests ordered during 6,736 inpatient admissions at a single hospital. In all, more than one-third of admissions (37.7%) had at least one test that was not reviewed before discharge, and 28% had unreviewed results two months postdischarge. Of these, 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.

After analysis, the researchers found that 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 two months. Of all of the unreviewed tests, 14.7% of those at discharge and 10.8% of those at two months later had abnormal test results. In all, about two-thirds of all unreviewed, abnormal results came from tests ordered on the day of discharge. The study was published online as a research letter on August 13, 2012, in Archives of Internal Medicine.

“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,” suggested lead author to Enrico Coiera, MBBS, PhD. “This information can be used to trigger computer alerts when tests are being ordered electronically. Alerts could advise clinicians either that it is unlikely those results will be posted before discharge, or that the tests simply have a high risk of being missed.”

Related Links:
Australian Institute of Health Innovations
St Vincent's Hospital