An Electronic Clinical Surveillance System to Reduce Failure to Follow Up Abnormal Lab Results and Failure to Order Needed Tests: Description and Methods.

Abstract

Background: Failure to follow up abnormal test results in a timely manner is a widespread issue in outpatient settings. The etiologies of this problem are multidimensional and vary across settings. While there is currently no widely used intervention to address these issues, multiple studies have noted that there is a need for multifaceted monitoring systems and quality improvement collaboratives to approach this problem.

Methods: Kaiser Permanente Southern California (KPSC) implemented a program called SureNet, which addresses the issue of missed laboratory results. KPSC is an integrated healthcare delivery system serving approximately 4.8 million members across 14 hospitals and 200 medical offices. SureNet operates as an electronic clinical surveillance system to detect lapses in care, with a particular focus on ambulatory tests. The functions of SureNet interventions include prompting a specific treatment, a follow-up laboratory test, or a specialist referral.

Results: Since its implementation in 2006, SureNet has grown to encompass more than 80 distinct programs, 39 of which focus on missed laboratory tests. The median number of measured interventions in a program was 4971 (range 60-182 249), and the measured percentage of successful interventions was 61% (range 4%-93%). Outcomes demonstrate that SureNet effectively closes care gaps that may have otherwise been missed.

Conclusion: KPSC's SureNet represents a potentially generalizable example of an electronic clinical surveillance program that can effectively mitigate the problem of lack of timely follow-up on abnormal laboratory results at scale. SureNet provides a blame-free approach that prioritizes patient care and outcomes.