International Journal for Quality in Health Care, 2022, 33(4), 1–6 DOI: https://doi.org/10.1093/intqhc/mzab158 Advance Access Publication Date: 28 December 2021 Original Research Article Improving results management processes in an acute hospital using a multi-faceted approach DARREL KOH 1 , TRACY WEE 1 , MICHELLE FONG 1 , XIAOHUI TAN 1 , RUDYANNA TAN 2 , SHALINI MENON 2 , JOEY GOH 2 , STEPHANIE TEO 1 , JOANNA CHIA 1 , WILLIAM KRISTANTO 2 , and GHEE HIAN LIM 1 1 Department of Medical Affairs, Ng Teng Fong General Hospital, JurongHealth Campus, National University Health System, 1 Jurong East Street 21, Singapore 609606, Singapore 2 Deparment of Medical Informatics, Ng Teng Fong General Hospital, JurongHealth Campus, National University Health System, 1 Jurong East Street 21, Singapore 609606, Singapore Address reprint requests to: Darrel Koh, Department of Medical Affairs, Ng Teng Fong General Hospital, JurongHealth Campus, National University Health System, 1 Jurong East Street 21, Singapore 609606, Singapore. Tel: +6716 5432; Fax: +65 6379 3050; E-mail: darrel_koh@nuhs.edu.sg Abstract Background: Radiological examinations and laboratory tests are routinely ordered by hospital physicians as part of the care plan to diagnose and treat patients. However, the failure to actively review and follow-up on these results pose a signifcant problem to patient safety. A study team was formed to mitigate the clinical risks of poor results management, which was identifed as a top clinical risk in our organization, in order to make improvements to the results management process and to ensure the timely review, acknowledgement and follow-up of test results. Objective: This study was carried out to improve results management processes and ensure the timely review, acknowledgment, and follow-up of test results, in order to mitigate the clinical risks posed to patient safety. Methods: The institutional expectations of results management were set and published as a hospital policy, which was communicated to all clin- ical departments for compliance. Improvements to the electronic medical records system were made to facilitate the results acknowledgement process, and physicians were engaged to educate them on the importance of results management. Results: The study team observed a decrease in unacknowledged results from approximately 16000 in March 2017 to 2673 in December 2020. The compliance rate for acknowledgement results increased from a monthly average of 83.7% (from March to December 2017) to a monthly average of 99.3% (in 2020). The risk score for results management decreased from 16 to 6.5 and was excluded from the organization’s top clinical risks. Conclusion: This study showed the importance of both system improvements and culture changes that are required to improve the process of results management and provides a step forward for the hospital to safeguard patient safety and mitigate clinical risk. Key words: clinical risk, electronic medical records, information technology systems, results management Introduction Radiological examinations and laboratory tests are routinely ordered by hospital physicians as part of the care plan to diagnose and treat patients. However, the failure to actively review and follow-up on these results runs the risk of missed diagnoses, thus compromising on the quality of care for patients and resulting in poor patient outcomes [1–3]. Neg- ligent misdiagnoses may also result in medical malpractice lawsuits; in 2019, a lawsuit was fled against a local health- care institution that was reported for negligence that resulted in a delayed diagnosis of lung cancer in a patient [4, 5]. This sparked a nationwide conversation on the importance of having a proper system for results management [6]. Our organization—a regional hospital in the western part of Singapore—was built with physical and technological infrastructures designed to provide seamless medical care from patient admission to discharge and follow-up appoint- ments, which was operational from June 2015. Simultane- ously, the electronic medical records (EMR) system (EPIC) was set up to leverage on the advancements in information technology, which would help physicians in the ordering, reviewing, and fnalization of test results in order to provide optimal medical care to patients [3, 7–9]. In 2017, the hospital’s Clinical Risk Management Com- mittee discovered that there were more than 17 000 abnor- mal results unacknowledged in the EMR system, several of which were related to serious reportable events and clinical complaints—with a score of 16 on the risk matrix (Figure 1). The organization thus identifed the delay or non-review of clinical results to be a top clinical risk and an organizational key focus area. A study team was convened to analyse the issue and to ensure the timely acknowledgement, review, and follow-up of test results. Based on previous research done, the team found stud- ies that underscored the importance of having defnitions of result types, delineating physician responsibility for follow- up of tests, and performing audits to ensure compliance with implemented processes [10]. Other studies have also shown Received 2 August 2021; Editorial Decision 12 December 2021; Revised 25 October 2021; Accepted 16 December 2021 © The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com Downloaded from https://academic.oup.com/intqhc/article/34/1/mzab158/6485219 by guest on 01 June 2023