Delays Among Laboratory Results Delivered Via EHR Notification Messages
James A. Mays MD; Jason M. Baron MD; Anand Dighe MD
Department of Pathology
Massachusetts General Hospital, Boston, MA
Although clinical laboratories alert clinicians to “critical” test results for their patients via
telephone or other rapid means, such critical callback procedures typically apply only to the
most immediately life-threatening results. Results that are clinically time-sensitive but not
critical are typically not called and only reported using electronic health record (EHR)
functionality, risking delayed result review. In addition to posting the result in the patient’s
electronic chart, our EHR sends clinicians e-mail-like “In basket” messages with new test results
on their patients. To enable the development of an improved result communication process,
we analytically assessed current reporting protocols using creatinine testing as an example.
We evaluated meta-data from 6,025 outpatient In basket messages reporting high creatinine
results sent through our hospital’s EHR (Epic Systems, Verona WI). Meta-data included
recipient, result value, creation timestamp, message interaction timestamp, and message
status at the time of query. We excluded patients with a history of renal failure. We calculated
the time from result release until results were seen by providers.
Among the 6,025 abnormal creatinine results, there was wide variation in notification time.
The median time between from result reporting to review was 46.1 hours (Nephrology: 48.3
hours; Transplant: 28.7 hours; Other: 47.8 hours). By contrast, the 90th percentile was 20.0 days
(Nephrology: 29.3 days; Transplant: 8.1 days; Other: 22.25 days). These findings were not
limited to a subset of providers: when evaluated as individuals, the median provider 90th
percentile “time to notification” was 6.1 days. Notifications of abnormal results remaining
unread > 3 days represented 2,429 out of 6,025 (40.3%) of messages.
There is wide variation in the time to complete delivery of non-critical creatinine results to
ordering providers. Some of these results likely represent sudden changes in patient status not
seen promptly by providers and may have clinical consequences. One important caveat is that
in some cases, providers may have seen the results by another method than the In basket
message. We are developing an EHR-based intervention to follow up on high-risk results not
reviewed in a timely fashion and will present this strategy.