Variation in the Management of Test Results after Hospital Discharge: A Pediatric Safety Concern.

Abstract

Introduction: Delay or failure to follow up tests pending at discharge (TPAD) is a major safety concern and a focus in the literature, but few studies exist in the pediatric context. We aimed to explore pediatric hospital medicine physicians' practices and perceptions of the management of TPAD.

Methods: Surveys were provided to hospitalists and residents at a single institution using selected questions from a published national adult primary care survey and newly developed questions. Results were analyzed using descriptive statistics and Fisher's exact tests.

Results: Surveys were completed by 25 hospitalists (89%) and 25 residents (68%). Forty-four percent (n = 11) of hospitalists reported missing test results, yet only 18% (n = 2) agreed that this error led to a delay in care. Seventy-six percent (n = 19) of hospitalists reported lacking adequate assistance to manage TPAD. There is uncertainty about who is responsible for managing TPAD among 88% (n = 22) of hospitalists and 92% (n = 23) of residents. Hospitalists were more likely than residents to use cognitive reminders (72% versus 20%, P = 0.0005). Many hospitalists (80%, n = 20) and residents (80%, n = 20) agreed that TPAD management is a safety issue, and nearly all hospitalists (88%, n = 22) and residents (96%, n = 24) want a standardized process. Residents were more likely to desire a shared responsibility (68% versus 32%, P = 0.02). Only 56% (n = 14) of hospitalists had formal education in result management; 76% (n = 19) of residents desired training.

Conclusions: Pediatric hospitalists and residents are concerned about TPAD management, and there is considerable variability in current practices. Developing a standard process is supported by nearly all.