Impact of EMR Automated Results Routing Tool Implementation on Notification of Inpatient Endoscopy Biopsy Results

      Background

      Mucosal biopsies are often obtained during inpatient endoscopies to aid diagnosis. Up to 75% of patients are reported to have pending test results at discharge. Incomplete result communication to patients can lead to patient anxiety and poor outcomes. This study aimed to evaluate the impact of a systemwide electronic medical record (EMR) update on result communication.

      Methods

      The researchers retrospectively reviewed 100 inpatient endoscopies pending histopathology results at discharge to see if finalized results were communicated to the patients within 30 days. The same metric was studied after implementation of an EMR update that automatically routed results to the supervising endoscopist, by reviewing another 100 inpatient endoscopies during which biopsies were obtained. Follow-up rate pre– and post–EMR update was compared.

      Results

      Prior to the update, 47/77 (61.0%) histopathology results were communicated to the patients. Of the 30 nonreported cases, 17 showed nonspecific/chronic inflammation, 8 had no abnormal findings, 3 showed hyperplastic colon polyps, and 2 had colonic tubular adenomas. Following the EMR update, 65/71 (91.5%) of pathology results were communicated, demonstrating an increase of 30.5 percentage points in the rate of follow-up (95% confidence interval [CI] = 17.7–43.0, p < 0.0001).

      Conclusion

      This study observed that 39.0% of inpatient endoscopic mucosal biopsy results in one health care system were not communicated to the patients. Implementation of a systemwide EMR intervention reduced this to 8.5% by shifting the responsibility of result communication to the endoscopy team. Similar EMR enhancements can be applied to other pending test results in health care systems with similar issues.
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      References

        • Peery AF
        • et al.
        Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: update 2018.
        Gastroenterology. 2019; 156: 254-272.e11
        • Cassell BE
        • et al.
        Do consultants follow up on tests they recommend? Insights from an academic inpatient gastrointestinal consult service.
        Dig Dis Sci. 2017; 62: 1448-1454
        • Callen J
        • et al.
        The safety implications of missed test results for hospitalised patients: a systematic review.
        BMJ Qual Saf. 2011; 20: 194-199
        • Greene MA
        • et al.
        Matching colonoscopy and pathology data in population-based registries: development of a novel algorithm and the initial experience of the New Hampshire Colonoscopy Registry.
        Gastrointest Endosc. 2011; 74: 334-340
        • Wabe N
        • et al.
        Pending laboratory test results at the time of discharge: a 3-year retrospective comparison of paper versus electronic test ordering in three emergency departments.
        Stud Health Technol Inform. 2018; 252: 164-169
      1. Altman DG Statistics with Confidence: Confidence Intervals and Statistical Guidelines. 2nd ed. BMJ Books, London2000
        • Lyons MD
        • et al.
        Preventing breakdowns in communication: teaching patient-centered posthospital care transitions to medical students.
        MedEdPORTAL. 2016 Aug 5; 12: 10435
        • Whitehead N
        • et al.
        Interventions to improve follow-up of laboratory test results pending at discharge: a systematic review.
        J Hosp Med. Epub. 2018 Feb 28;
        • Dalal AK
        • et al.
        The impact of automated notification on follow-up of actionable tests pending at discharge: a cluster-randomized controlled trial.
        J Gen Intern Med. 2018; 33: 1043-1051
        • Darragh PJ
        • et al.
        A systematic review of interventions to follow-up test results pending at discharge.
        J Gen Intern Med. 2018; 33: 750-758
        • Dalal AK
        • et al.
        Impact of an automated email notification system for results of tests pending at discharge: a cluster-randomized controlled trial.
        J Am Med Inform Assoc. 2014; 21: 473-480
        • Georgiou A
        • et al.
        Monitoring the impact of the electronic medical record on the quality of laboratory test ordering practices.
        Stud Health Technol Inform. 2013; 188: 33-38
        • Thompson W
        • et al.
        Computerized physician order entry of diagnostic tests in an intensive care unit is associated with improved timeliness of service.
        Crit Care Med. 2004; 32: 1306-1309
        • El-Kareh R
        • et al.
        Impact of automated alerts on follow-up of post-discharge microbiology results: a cluster randomized controlled trial.
        J Gen Intern Med. 2012; 27: 1243-1250
        • Laxmisan A
        • et al.
        Effectiveness of an electronic health record-based intervention to improve follow-up of abnormal pathology results: a retrospective record analysis.
        Med Care. 2012; 50: 898-904