A missed or late diagnosis has obvious repercussions for patients, but for the medical staff who fails to contact or explain a test result or treat a disease, consequences can also be dire. One article published by American Medical News states that “missed appointments and failures to follow up pose some of the greatest legal risks for physicians,” and yet delayed treatment continues to plague the medical system today.Why might treatment be delayed? What are the consequences of such a delay, and how can this phenomenon be minimized? Below, we have a breakdown of the important factors affecting this issue as well as some steps that can be taken to reduce it.
Delayed treatment can happen for many reasons, but one serious, preventable cause is a medical team’s failure to follow-up test results with a patient. Most primary care practices are communicating with multiple laboratories that may or may not be electronically connected, making it easier for results to get lost, forgotten, or not passed on to the correct physician.Across 19 different studies conducted by the Center for Health Systems and Safety Research, it was discovered that abnormal laboratory results were not followed-up within 30 days between 6.8% and 62% of the time.
Research indicates that problems in communication are a factor in up to 80% of medical malpractice cases.This includes failure to follow-up, and other instances where poor communication, or a lack of it, between different specialists, primary care physicians, and departments lead to a patient never being notified of a critical diagnostic or screening test result. If documentation is inadequate or incomplete, an effective test result tracking system isn’t implemented at the hospital or clinic, or the growth in diagnostic test volume keeps the referring clinician from being notified, delay in treatment can occur.
If a patient does not have the opportunity to learn of their test results and go over a treatment plan with their physician, missed or delayed diagnoses can lead to serious harm for the patient, or even death. Such harm includes the progression of an injury or condition; for example, if a cancer diagnosis is communicated too late, it could result in the patient having to undergo intensive treatment that might otherwise have been avoidable. Such delays in treatment can also become the basis of a medical malpractice suit.
What can be done?
It is critical that the clinician see the test results, interpret them correctly, determine the appropriate response, and contact the patient and ensure they carry out the treatment plan.One way to ensure this happens is by using systems devised to expedite follow-ups with patients.For example, a clinic at the University of Wisconsin lowered no-show rates from 33 to 18 percent by interviewing no-show patients, devising a new scheduling process, and double-booking the number of slots corresponding to its no-show rate.Additionally, hospitals can become more diligent about making reminder calls, and should work especially hard with non-English speakers and patients with neurological conditions to improve compliance.Physicians need to be certain that they engage patients in following up on pending tests, educate them about the importance of such tests, and make sure they themselves are responsibly obtaining results and correct contact information for patients.Finally, doctors should be certain they document the conversations they’ve had with patients emphasizing the tests they’ve received and their importance, as this is crucial from a legal standpoint.
Even if the patient shows up to an appointment, the clinical evaluation is performed well, and appropriate tests are ordered and conducted well, if the clinician and patient can’t execute a treatment plan based on the results, serious trouble can await both patient and physician. Everyone involved needs to be vigilant, and though it may seem costly, hospitals that spend the money and energy ensuring patients are being treated in a timely fashion will likely find that their satisfaction ratings and reliability as an institution will be much more secure.
Lerner, Barron H., “When Patients Don’t Follow Up,” NewYorkTimes.com, Nov. 13, 2014, https://well.blogs.nytimes.com/2014/11/13/when-patients-dont-follow-up/?mcubz=3
Callen, Joanne L., Johanna I. Westbrook, Andrew Georgiou, and Julie Li, “Failure to Follow-Up Test Results for Ambulatory Patients: A Systematic Review,” NCBI.gov, Dec. 20, 2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445672/
“Failure to Communicate Test Results,” The Tinker Law Firm, n.d., http://www.seattlemalpracticelawyers.com/legal-services/medical-malpractice-lawyer/failure-to-communicate-test-results/
Shapiro, David, “Delay in Treatment: Failure to Contact Patient Leads to Significant Complications,” Patient Safety Network, Feb. 2013, https://psnet.ahrq.gov/webmm/case/290/delay-in-treatment-failure-to-contact-patient-leads-to-significant-complications
Lerner, “When Patients Don’t Follow Up”
Shapiro, “Delay in Treatment”