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When no news might be missed news: Closed loop reporting in healthcare

February 11, 2021

No news is good news, right? Not when it comes to a critical test result that falls through the cracks. Without an effective workflow that ensures every test result reaches the right provider(s) in a timely manner, diagnostic errors can occur and compromise patient safety.

What is closed loop reporting and communication?

Closed loop reporting and communication means every test result is sent, received, and addressed in a timely manner. In December 2019, The Joint Commission issued Quick Safety Issue 52, which recounted the story of a patient who had a suspicious finding on her mammogram. Due to a series of manual communication errors, the finding never reached the responsible provider. The patient assumed she was fine only to learn a year later she had progressed to stage 3 breast cancer. To prevent patient harm resulting from diagnostic errors due to gaps in test result communications, Quick Safety Issue 52 focused on advancing patient safety by recommending closed loop communication.

The Joint Commission identified the timely reporting of results of critical tests and diagnostic procedures as a National Patient Safety Goal in 2005 (NPSG.02.02.01). Research also shows that “failure to close the communication loop is also among the contributing factors to high-severity medical malpractice claims.”

You can learn more about general industry regulations relating to how critical test results should be handled in this related blog post on why today’s critical test result processes are broken.

A look at the numbers

Not only can there be logistical inefficiency in the process of sharing critical test results today, but sometimes results do not reach their intended destinations and are lost altogether. A study from the Journal of General Internal Medicine showed up to 62% of lab tests and up to 35.7% of radiology tests lacked follow-up. Another study of 7,438 imaging neuroradiology studies showed 13.1% were never reviewed by neurologists. Sadly, some of these oversights resulted in dire consequences such as the missed cancer diagnosis described above.

Manual processes cause problems

How does this happen? You may be surprised to learn that most hospitals, reference labs, and radiology units use manual processes to communicate critical results — phone calls, printed results, and faxes. The phone remains the most common method of communicating critical test results, with technology solutions generally being under-utilized. This means lab and rad techs waste time trying to track down busy physicians, and nurses are pressed into action as go-betweens to track down and deliver test results. All the while, patient care may be delayed and compromised.

A standard critical test result workflow

Typical workflows for test result communication include the lab or rad tech first manually calling the nurse caring for the patient on the floor. This kicks off a cumbersome and inefficient process for all involved:

  1. To communicate with the nurse, the lab or rad tech manually calls the unit, and usually the health unit coordinator will answer.
  2. The lab or rad tech will ask to speak with the nurse caring for the patient and is usually placed on hold.
  3. When the nurse is available, they will get on the line.
  4. The lab or rad tech will identify themselves and give the nurse the patient’s demographic information along with the critical test result.
  5. For lab results, the College of American Pathologists (CAP) requires the nurse to read back the result information.
  6. After that, the communication is documented in the necessary systems, which could include a laboratory information system (LIS), a radiology information system (RIS), or the EHR.
  7. Then the process repeats when the nurse must follow the same steps to communicate the critical test result to the responsible provider. This includes finding the physician and telling them the critical result, and documenting it in the EHR.

Putting patient care and test result reporting compliance front and center

It’s time to embrace current technological advances to automate critical test result communication workflows. Let’s walk through what automated, closed loop reporting looks like and how it reduces the results communication timeline.

  • A patient’s test result is released from the LIS or radiology information system (RIS) and flagged as critical.
  • The system receives the HL7 data feed and identifies this as a critical result.
  • The HL7 output triggers the critical result reporting workflow.
  • The system automatically sends the alert to the responsible provider.
  • The provider receives the critical result on their preferred device (smartphone, laptop, pager, etc.).
    • If that provider is not available, the system automatically escalates the notification to the next designated provider.
  • Now that the provider has the result, they can quickly respond and create the appropriate care plan for the patient.
  • The system records the communication transaction between the provider and the lab/radiology, and the loop is closed. This can occur in a source system such as the RIS or LIS, and/or the EHR.
  • The system generates reports for accreditation to show compliance during regulatory audits.

How to implement closed loop test result reporting and communication in healthcare

Solutions such as Spok Go® are now able to take passive systems like EHR, LIS, and RIS and quickly transmit patient results to the responsible provider. With actionable results reaching providers quickly and being documented in the system, patients can get treatment sooner. This eliminates manual processes and phone calls, ultimately improving outcomes in many cases. Additionally, closed loop reporting capabilities ensure responsible providers acknowledge critical results and use reports to visualize transactions for accreditation audits.

Closed loop workflow example

Benefits of a closed loop result communication process

  • Safety: Respond rapidly to emergent situations where patients’ health and safety are on the line. Ensure all critical results are followed up on so they don’t fall through the cracks. Reduce the chance of errors related to misunderstood or inaccurately transcribed results delivered via phone.
  • Compliance: Meet Joint Commission, CAP, and American College of Radiology (ACR) regulations for the timely communication and documentation of critical results. Leverage powerful reporting capabilities to simplify the audit process.
  • Efficiency: Reduce time spent waiting on the phone and searching in the EHR for results with automated test result delivery.
  • Cost Control: Enable highly compensated clinical staff to focus on their primary duties without wasting time playing voicemail tag chasing providers with test results.

What you can do

Now that you’ve learned about the need for improving critical test result reporting, perhaps it’s time to look at what’s happening in your own organization today. Considering the challenges associated with manual critical results reporting processes, you may want to begin envisioning the advantages of automating these workflows.

Start by investigating how you currently communicate critical results and what quality initiatives may be afoot for improving these steps. Ask if providers receive results in a timely manner and whether care teams are able to easily coordinate patient care after receiving abnormal test results. Once you start the discovery process, you can explore the options for improving efficiency and enhancing compliance with closed loop reporting, while boosting patient safety at the same time.

 

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Patient Safety
Matt Mesnik

By Matt Mesnik, MD, Chief Medical Officer
Dr. Mesnik is an emergency physician and business executive with more than 30 years of healthcare, health IT, and medical device experience. He is a former emergency department and urgent care medical director. He is also an accomplished healthcare executive and serial entrepreneur with a reputation for bringing innovative solutions to market, leveraging technology, developing strategic partnerships, practice management, and leadership. He was the CMO of Aprima Medical Software, CVS-MinuteClinic, Medibio, and Sanso Health, and a number of other HIT and medical device companies.