Variation in the Management of Test Results after Hospital Discharge: A Pediatric Safety Concern

Delay or failure to follow up tests pending at discharge (TPAD) is a major safety concern and a focus in the literature, but few studies exist in the pediatric context. We aimed to explore pediatric hospital medicine physicians' practices and perceptions of the management of TPAD.

Surveys were provided to hospitalists and residents at a single institution using selected questions from a published national adult primary care survey and newly developed questions. Results were analyzed using descriptive statistics and Fisher's exact tests.

Surveys were completed by 25 hospitalists (89%) and 25 residents (68%). Forty-four percent (n = 11) of hospitalists reported missing test results, yet only 18% (n = 2) agreed that this error led to a delay in care. Seventy-six percent (n = 19) of hospitalists reported lacking adequate assistance to manage TPAD. There is uncertainty about who is responsible for managing TPAD among 88% (n = 22) of hospitalists and 92% (n = 23) of residents. Hospitalists were more likely than residents to use cognitive reminders (72% versus 20%, P = 0.0005). Many hospitalists (80%, n = 20) and residents (80%, n = 20) agreed that TPAD management is a safety issue, and nearly all hospitalists (88%, n = 22) and residents (96%, n = 24) want a standardized process. Residents were more likely to desire a shared responsibility (68% versus 32%, P = 0.02). Only 56% (n = 14) of hospitalists had formal education in result management; 76% (n = 19) of residents desired training.

Pediatric hospitalists and residents are concerned about TPAD management, and there is considerable variability in current practices. Developing a standard process is supported by nearly all.