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Hospitalist Q&A: How should hospitalists deal with imaging and laboratory results that are returned after a patient is discharged?

Hospitalist Leadership Connection, April 29, 2008

Q: We have a fairly new hospitalist program. We are having difficulty following up on laboratory and medical imaging results that are returned after a patient is discharged. The hospitalists feel that the results should go to the patient’s primary care physician. Often this is a dead end and nothing is done. I am concerned that the liability remains with the ordering physicians, and they should be responsible for following up on the tests that they order. How have other hospitalist programs dealt with this issue?

Christine O'Farrell, BSN, CPHQ
Director of Clinical Services/Risk
Carson Valley Medical Center
Gardnerville, NV

A:  Hospitalists should consider visiting their referring providers’ offices and discussing the need for the referring providers to address the outstanding lab and imaging results. Hospitalists can also develop a system to transmit the outstanding results. Such as system may include:

• Calling the patient’s primary care physician (PCP) at the time of discharge to inform him or her of the outstanding studies and need for follow up
• Clearly dictating the outstanding results in the discharge summary 
• Creating a form they can fax to primary care providers’ offices advising them of outstanding studies
• Asking the hospital for a copy of the patient’s results for their records (when the study is ordered or at discharge if the results were late in arriving). Hospitalists should then transmit a copy to the PCP’s office and follow up to confirm the PCP received it   

Hospitalists should track outliers to improve educational efforts, because not following up on imaging and laboratory results could have medical, legal, and patient safety repercussions. For instance, hospitalists may need to follow up with the patient to ensure closure on outstanding issues, although this is not a desired process. In addition, the hospital may need to consider disciplinary action against repeat offenders.

KENNETH G. SIMONE, DO, is a board-certified family physician in private family practice in Brewer, ME. Simone has authored and co-authored several hospitalist books, including The Hospitalist Program Management Guide, Second Edition; Hospitalist Case Studies: Tactics and Strategies for 10 Common Hurdles; and Tools and Strategies for an Effective Hospitalist Program, all published by HCPro, Inc., in Marblehead, MA.

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