Direct reporting of laboratory test results to patients by mail to enhance patient safety

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Abstract
BACKGROUND: Missed test results are common in clinical practice and compromise patient safety. Direct reporting, whereby testing centers systematically notify both patients and providers of important test results, constitutes a potential solution, but provider acceptance is unknown. OBJECTIVE: To assess provider interest in direct reporting of selected test results and how interest varied across different tests. DESIGN, SETTING, AND PARTICIPANTS: Survey of primary care physicians at a tertiary care academic medical center. MEASUREMENT: Five-point Likert scores were used to gauge each physician’s interest (1=not at all interested to 5=very interested) in scenarios pertaining to the direct reporting of 3 diagnostic tests of low (DXA scan), intermediate (genital herpes testing), and high (breast biopsy) “emotional impact” and whether interest varied with each test’s result (normal vs abnormal). Physicians were also asked to cite specific advantages and disadvantages of direct reporting. RESULTS: The response rate was 73% (148/202). Physician interest in direct reporting decreased progressively as scenarios shifted from low (DXA scan) to high (breast biopsy) emotional impact (P<.001); interest in direct reporting was also higher when results were normal rather than abnormal (P<.001). Common advantages of direct reporting cited by respondents were reductions in workload (selected by 75% of respondents) and reductions in missed diagnoses (38%). The most common concerns were that patients would become unnecessarily frightened (70%) and would seek unreliable information (65%). CONCLUSION: Direct reporting of selected test results to patients is one system for insuring that important results are not missed, but implementation should consider the specific test in question, the test result, and provider preferences.