Most doctors lag in reviewing test results, study says

Primary care doctors, who sometimes review hundreds of test results each week, reported in a new study that delays in reviewing results for patients are common, and many said they are unhappy with how they manage these crucial pieces of information.

Researchers at Brigham and Women's Hospital mailed surveys to 262 physicians affiliated with the Brigham and with Massachusetts General Hospital about how they handle test results. Failure to follow up on abnormal results is one of the most pressing patient safety issues and a leading reason for malpractice claims. It's also a vexing problem for busy doctors, some of whom review as many as 800 pieces of data, 40 radiology reports, and 12 pathology reports a week, according to previous Brigham research.

Eighty-three percent of doctors said that in the past two months they had reviewed at least one test result "they wished they had known about earlier," according to the study, published in yesterday's Archives of Internal Medicine.

Nearly one in five primary care doctors said this type of delay happened five or more times during the previous two months.

Doctors generally spent an hour and 15 minutes a day reviewing test results, informing patients, and developing follow-up plans.

Dr. Eric Poon, lead author and a Brigham physician, said one problem is that most doctors' offices receive test results on hundreds of pieces of paper.

"A lot of information has to be digested by the clinician, and to make things worse, the tests they order come back anywhere from an hour to several weeks later.

"It's easy to forget to look in a patient's chart to see if the result has come back yet."

In many instances, he said, delays are harmless. But in rare cases, a doctor who misses an abnormal result may create serious delays in care for the patient, such as when a chest X-ray for possible pneumonia reveals that the patient has lung cancer and requires immediate treatment.

The survey suggests that doctors need more reliable systems for tracking test results, Poon said.

He and many other Brigham doctors now use an electronic system that collects patients' test results in one place, similar to an e-mail in-box. The system highlights abnormal results, so the doctor can review them first.

Mass. General and the Brigham are rolling out the system to the primary care practices affiliated with the hospitals.

Liz Kowalczyk can be reached at kowalczyk@globe.com.