An Interprofessional Initiative to Address Tests Pending at Discharge for Hospitalized Pediatric Patients

Area of Science:

• Pediatric Hospital Medicine
• Healthcare Management
• Patient Safety

Background:

• Hospitalized children are often discharged before all laboratory tests are finalized.
• Inadequate follow-up of tests pending at discharge (TPAD) poses a risk for medical errors.
• A collaborative initiative was piloted to address TPAD in a pediatric hospital medicine section.

Purpose of the Study:

• To define roles for case managers and pediatric hospital medicine clinicians in managing TPAD.
• To establish an effective communication process for TPAD.
• To improve patient safety by ensuring timely follow-up of outstanding lab results.

Main Methods:

• An interprofessional team conducted a current state assessment, including clinician surveys on TPAD follow-up.
• Electronic health records identified 1450 TPAD; 26 common labs were selected for case manager follow-up.
• A shared electronic inbox was implemented for case managers to monitor TPAD twice daily.

Main Results:

• The pilot initiative, involving case managers and clinicians, proceeded through four phases over six months.
• Duplication of work and limited value were observed when case managers handled straightforward TPAD.
• The pilot was discontinued due to identified inefficiencies in the established workflow.

Conclusions:

• The initial strategy of case managers handling straightforward TPAD proved inefficient.
• A revised approach may involve case managers focusing on complex TPAD.
• Future collaboration could enhance communication between case managers, primary care providers, and families for improved TPAD management.