Endorsing: closing the loop on diagnostic tests in electronic health care records

The Oxford University Hospital NHS Trust (OUH) had introduced a policy to improve the timely endorsement of diagnostic tests. However, performance in the Oxford Kidney Unit (OKU) has been consistently below the OUH target of 85%. This project was undertaken to improve endorsement within the OKU. Weekly percentages of all diagnostic test results that were endorsed within 7 days of reporting were monitored as our main outcome measurement. During the intervention period, four plan-do-study-act (PDSA) cycles were undertaken each lasting 6 weeks. Introduced changes included interventions to develop a team-based approach and practical tools to enhance compliance, such as creating clinical worklists, a guidance document on endorsement and an endorsement newsletter. Data was monitored for a further 6 months beyond the intervention period to ensure improvement was sustained. There was a significant improvement in endorsement to above 85% by the end of the second PDSA cycle. This was maintained throughout the project and for a further 6 months beyond the intervention period. Our systematic approach to improving the endorsement of results is potentially transferable to other healthcare organisations using electronic healthcare records for clinical care.