Test results are still ignored despite electronic alerts

Ordering imaging tests is relatively easy. Remembering to check the results and act on abnormal findings is much harder, so many electronic medical records systems incorporate alerts and reminders directing doctors to abnormal results. Some still fall through the cracks, however. In one study from the US, nearly one in five alerts was not acknowledged by the doctor who ordered the test, and 7.7% (92/1196) of alerts were not acted on within a month. All the alerts reported abnormal imaging tests. Most of the missed abnormalities in this study would have had important clinical implications if the authors hadn’t contacted the doctor responsible and encouraged them to do something. Two thirds (62/92; 67.4%) of the “near misses” were suspected cancers.

The authors analysed alerts sent by the electronic medical record system at six linked outpatient facilities in Texas to more than 500 different healthcare providers. Alerts backed up by a telephone call from the radiologist were much less likely to be ignored (odds ratio 0.12, 95% CI 0.04 to 0.38). Alerts sent to two providers instead of one were more likely to be ignored (1.99, 1.06 to 3.48), possibly because dual alerting—intended as a safeguard—actually blurred lines of responsibility.

Electronic warnings clearly don’t eliminate the problem of missed test results, say the authors. They suggest leaving alerts on doctors’ screens for longer, leaving them on until a doctor records taking action, and taking steps to cut down the background noise created by unnecessary or redundant alerts.