Failing to diagnose and/or delay in diagnosis accounts for approximately 25% of all malpractice claims. Many adverse events can be directly tied to the fact that a patient's test results have been unread or unreported. If a test is important enough to order, it is important enough to track the results. There are a multitude of things that may keep a patient from complying with your recommendations, not the least of which are fear, expense, and logistics.

It is not enough to assume that the results received reflect the ones ordered or to assume that all patients have obtained the appropriate tests. It is necessary to verify that the test ordered matches the results received. Double-checking for a patient's results at their next visit is certainly helpful but may not be efficient as not all patients return as requested. Merely asking patients to call if they have not heard from you regarding results, again, is not sufficient. To many patients, no news is good news; or, if it were really important, the physician would call.

 Risk Factors:

• Not knowing when lab reports are missing.

• Filing reports, diagnostic studies and lab work without physician's review and signature.

• Absence of or inadequate protocol for handling the flow of clinical information.

• Absent or inadequate guideline for follow-up and tracking of test results, diagnostic studies, consults, etc.

Suggested Approaches:

1. Establish a written protocol for follow-up and tracking of test results.
2. Verify receipt and review of the results in a timely manner. Check off when the results are received.
3. Record the results in the medical record.
4. Report the results to referring or consulting physicians.
5. Follow up with the patient.
6. Follow up on any pending results.
7. Document all follow up.
8. All test results should be attached to the chart to be reviewed by the physician, initialed and dated prior to being put into the medical record.
9. The record needs to be clear as to who is responsible for the treatment of the patient.

Keep a log of pending test results, diagnostic studies, etc. Some practices have an area designated as pending. Charts are held out until all work, studies, etc. are completed.

Check off when the results are reported to the patient. Consider that abnormal results should be communicated to the patient by the physician.