Despite More Tests, Some Aren't Getting Results

MONDAY July 6, 2009 -- More than half of the time, test results revealing abnormalities in the aorta were not included in patients' electronic medical records within three months, new research has found.

Nearly a third of the time, still no record was found three years later.

The findings add to a growing body of research that is raising concerns about communication breakdowns between specialists, emergency room doctors, primary care doctors, nurses and their patients when sharing the results of diagnostic tests.

"We are using more and more diagnostic testing in medicine these days, those tests all have to be followed up on, and we don't currently have systems to do that," said study author Dr. Peter Cram, an associate professor of internal medicine at the University of Iowa Carver College of Medicine. "It used to be you'd spend a half-hour with your doctor and they'd order one test. Now they spend 15 minutes with you and order 30 tests."

The researchers examined medical data on 4,112 people who had computed tomography (CT) scans at the Veterans Affairs hospitals in Iowa City, Iowa, and Omaha, Neb.

About 11 percent, or 440 people, were found to have aortic dilations, or an area of the aorta that was weakened or bulging. The aorta, which runs from the heart through the chest and abdomen, is the main blood supply for the body.

Of those, 91 had new dilations that had not been previously noted in the medical record. Study participants had undergone the CT scans because of abdominal pain or kidney stones. The aortic abnormalities were found incidentally.

In 5 percent of the cases, radiologists notified clinical teams of the test results.

But in 58 percent of the new dilations, there was still no record of the dilation in the person's electronic medical record within three months of the CT scan. In 29 percent of the cases, there was no documentation of the aortic dilations after an average of three years.

No patients died as a result of the missed tests. Most of the dilations were small and probably not immediately dangerous, Cram noted.

But about 9 percent were 5.5 centimeters or larger, a condition that would typically be referred to a surgeon. Larger aneurisms are more likely to rupture, cause life-threatening bleeding.

The study appears in the July 7 issue of the Annals of Internal Medicine.

Dr. Andy Whittemore, chief medical officer at Brigham and Women's Hospital in Boston, said the study highlights a vexing issue for the medical profession.

"There's no question this is a major issue and a major source of medical errors," Whittemore said. "The study very clearly points out a very real shortcoming in our system and testifies to the difficulties we have communicating among specialists and primary care physicians, and primary care physicians and their patients."

Improved computer systems for tracking results would help, Whittemore said, as would making sure that the physician who orders a test also takes responsibility for making sure the results are interpreted, recorded and communicated properly.

Other studies have revealed similar problems with other types of diagnostic tests, including bone density scans and potassium and thyroid hormone levels. A study in the June 22 issue of Archives of Internal Medicine, involving 5,434 people aged 50 to 69 found that 7 percent of abnormal results were never communicated to the patient.

Part of the problem lies in the variable methods diagnostic tests are reported, Cram said. Some records are sent electronically, and others are sent by mail, fax or phone. Some results come back almost immediately, whereas others might take two weeks.

"If you add in a doctor who's not just seeing you but seeing 20 or 30 other patients in a day, it becomes an overwhelming job," Cram said.

And electronic records are not a panacea, he said, noting that the VA hospitals in which the study was done make extensive use of electronic record-keeping.

"This is a national problem, not a Veteran's Administration problem," said Cram, a health services researcher at the Iowa City Veterans Affairs Medical Center.

So what can patients do? Keep a written record of the diagnostic tests, including what they were for, Cram suggests. Find out when you should hear back on the results, he said, and if you haven't heard in a timely manner, make sure you or your doctor follows up.

"Ultimately, it's your health," Cram said. "Be proactive about it."

More information

The U.S. Agency for Healthcare Research and Quality has information on medical test results.

Posted: July 2009


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