Medical tests ordered on the day of hospital discharge have a high risk of not being followed up on by the ordering physician, reports Mei-Sing Ong, PhD in a research letter in the Archives of Internal Medicine on August 13th. Of 662,858 tests ordered for 6736 patients during their hospitalization, 3.1% of test results did not get reviewed before discharge. Two months later, half of those were still not reviewed. More than one-third of patients had at least one test result that was not reviewed prior to discharge. Most of the test results that went unreviewed were ordered on the day of discharge.
Twenty-one percent (21%) of results of medical tests ordered on the day of discharge were not looked at by a physician prior to discharge, compared with a 2% of failure rate for checking results on other days. This accounted for half of all unreviewed test results. Of the unreviewed tests, 14.7% had an abnormal result at the time of discharge, and 10.8% of the tests still unreviewed at 2 month had abnormal results. One explanation is that once the decision has been made to discharge a patient, tests ordered on discharge day are unlikely to change that decision, causing physicians to be less interested in following up.
The researchers recommend discharge policies that require computer alerts to be sent to physicians when ordering tests on discharge days asking them if they are medically indicated and to alert them afterwards when the results are available. Not only do discharge day orders waste money, but failing to follow up on medical testing is medical malpractice. If important information about an antibiotic treatment or bleeding times for coumadin are not followed up on, patients can suffer serious harm once they leave the hospital. Patients need to be aware of any tests done on their discharge date and to make sure that their physicians check the results. If it is worth the patients money to have the test done, it is worth a minute of the physician’s time to look at it.