Automating pending labs list into discharge summaries

Pending test results not communicated during the post-acute care transition may pose harm and lead to diagnostic errors in patients. This quality improvement initiative aimed to assess the effectiveness of pending labs communication by automating a list of pending labs into discharge summaries.

A SmartLink was developed in the EpicCare electronic health record that populates a list of pending labs and pathology studies and was added to the standard discharge summary template for hospitalists and resident physicians. A 2-month pre-post review of randomly selected discharge encounters was conducted to assess the frequencies of discharge summaries reporting pending labs, discharges with pending labs, discharges with eventually abnormal pending labs and discharges with results reported in follow-up notes.

Of the 291 pre-intervention encounters reviewed, 130 (44.7%) had one or more labs pending, compared with 115 (40.6%) of 283 post-intervention encounters. 35 (26.9%) of the pre-intervention discharge summaries mentioned all pending labs, compared with 104 (90.4%) post-intervention, p value <0.01. There was no difference in the frequency of discharge encounters with results reported in follow-up notes; however, a trend towards significance was observed for those with abnormal results.

Implementing an automated link that pulls pending studies into discharge summary templates drastically improved documentation of pending labs. However, given the complexity of post-acute care transitions, more work is needed to ensure receipt and follow-up of this crucial communication.