1. Closing the Gap on Laboratory and Radiology Patient
Callbacks after Discharge from the Emergency Department V. Ramana Feeser MD, Anne Jackson MS RN CEN & Barbara Stout PA-C
Virginia Commonwealth University Emergency Department, Richmond VA
Innovation Description
Lessons Learned
Figure 1: Laboratory Follow-Up Procedure
Gaps in communication occur with informing patients about abnormal laboratory (lab) and radiology (rad) tests that result after discharge from the Emergency Department (ED).
Our past process involved providers on clinical shifts reviewing lab and rad recalls (final rad attending read differs from preliminary rad resident read), contacting the patient by phone and updating the original ED note.
To improve our process, we standardized our practice by designating an APP on shift in our ED Clinical Decision Unit (CDU) to follow a daily process of reviewing labs and rad recalls
This step-wise procedure starts with phone calls to the patient, mailing regular and certified letters (if phone calls unsuccessful), documentation of communication using a template note called “Rad-Lab Results Addendum *ED which is added as a separate note in the electronic medical record (EMR)
If all efforts to communicate to the patient are unsuccessful, we add a problem to the patient’s problem list in the EMR.
By offloading busy clinical providers, we created a system where daily regular review successfully occurs and is documented.
When phone calls are unsuccessful, we contacted more patients by regular mail that had been hesitant to open or respond to the certified letter.
By using the separately identifiable template note, this highlights to any provider in our health system what to do if the patient returns and documents the efforts the ED took to provide the necessary follow-up and treatment that the patient required after ED discharge.
By adding the abnormal result to the patient’s problem list, patients can see these on discharge instructions and on patient portal. More patients and providers were contacting the ED when they saw this abnormal result.
Providers reviewing the problem list when patients returned for other visits to ED or anywhere in the health system could identify that this patient had an unaddressed abnormal result on their problem list.
Figure 2: Radiology Recall Procedure
Results of the Innovation
By implementing a system of daily regular review to a designated APP in our ED CDU, no patients are missed or delayed in being notified about an important finding.
Certified letters returned unopened and by sending regular mail too, more people called back to the ED.
The separate template note more clearly documents a callback result has occurred and is easier to identify by providers using the EMR.
Adding the problem to a patient’s problem list resulted in more patients being notified.
These improvements have closed some of the gaps that occur in communicating important laboratory and radiology callback results to patients after discharge from the ED.
This process can easily be translated to other organizations who have similar challenges with results after ED discharge.
Next steps: Collect data to measure the impact of this program’s success.