Background: Transitions of care from the inpatient to outpatient setting are a vulnerable period for patients, particularly when diagnostic results are not finalized until after discharge (1). Hospitalists may not be available to review results promptly, assuming outpatient providers will follow up on pending results. (2,3,4) Lack of clarity about who is following the result can lead to missed results or delayed follow up. (5,6) Recognizing these gaps and lacking a standardized plan, the need for a structured result management approach was identified.
Purpose: The REACT (Results Evaluation After Care Transition) program was developed to address this gap by implementing a systematic process for reviewing and acting on finalized results after hospital discharge. By creating a centralized workflow and accountability structure, REACT sought to improve communication between inpatient and outpatient providers, reduce diagnostic delays, and enhance the safety of care transitions.
Description: The hospitalist team at a 1,500-bed academic medical center developed a framework for management of results finalized after discharge by setting up an automated result-routing mechanism in the EHR. Each result in the shared in-basket was reviewed and logged into a database by dedicated hospitalist providers. Data from May through September 2025 was collected. During that time, 3701 unique results were routed. Of the total results reviewed, 754 were actively addressed by the REACT team (20%). Among these, 96 findings prompted a change in the patient’s management or follow-up plan. The remaining 658 results were forwarded to the appropriate outpatient providers to support continuity of care, accompanied by relevant clinical context to facilitate informed decision-making. Over the five-month period, several notable “great catch” cases emerged, underscoring the impact of the REACT intervention in preventing delays—or even complete misses—of critical clinical findings. Two key areas where near misses were most frequently identified included unexpected hematologic abnormalities observed on peripheral blood smears or serum protein electrophoresis (SPEP), and unanticipated antibiotic resistance patterns revealed in culture results. These cases highlight the importance of structured communication pathways in safeguarding patient outcomes and ensuring prompt clinical action.
Conclusions: Transitions of care remain a critical juncture in patient safety. The REACT program showed that a centralized approach to post-discharge result management reduces delays, enhances communication across care teams, and ensures all results are addressed. Leveraging automated routing within the EHR and dedicated hospitalist oversight, REACT ensured a timely review of a weekly average of 170 results. While similar post-discharge result management programs may exist at other institutions, the implementation of REACT was particularly novel and impactful at our hospital due to the scale and complexity of our hospitalist service, which manages over 19,000 discharges annually. The large, diverse patient population makes timely follow-up challenging, necessitating a centralized, systematic approach. REACT’s success in this high-volume setting underscores its potential as a scalable model for other large academic medical centers seeking to enhance diagnostic safety and continuity of care transitions.