Background: Failure to follow-up on lab tests and radiology results can lead to major patient safety concerns due to missed or delayed diagnoses and can be a cause for litigation for health care practitioners. With increasing patient loads, the volume of follow-up testing and clarifications to documentation needed for billing can be a significant burden to workloads and can add to provider burnout. In hospital medicine, where providers can be off clinically up to a week or more after a long clinical stretch, little is known about current practice and expectations for checking lab results and documentation queries during non-clinical weeks.
Methods: The UCHealth system in Colorado is comprised of 1 academic medical center and 11 community hospitals and uses the Epic electronic health record (EHR). In 2022, UCHealth hospitalist providers (both physicians and advanced practice providers) were asked to complete a survey on their practice and preferences for handling labs and documentation queries after completing their week on service. Questions included how often providers checked the EHR for pending labs after leaving service, if they commonly set alerts or email forwarding for key results, and whether they would be amenable to following up on results and documentation for off-service provider colleagues while they were on service. Providers were also asked for suggestions and thoughts around expectations for lab and documentation follow-up.
Results: 20% of hospitalist providers (N=59) responded (34% from community hospitals and 66.1% from the academic medical center). 56% responded they checked their EHR in-basket for results on labs and documentation queries 1-2 times during the week after leaving service, and 27% stated they never checked the EHR in-basket while off service. Few providers set an alert to ensure key results went to their EHR in-basket (17%) or forwarded results to their email as another way of alerting adverse results (13%). 35% of providers felt their ideal expectation was that patient care ends once they leave service, 35% expected that providers to check their inboxes once within 72 hours off service, and 14% thought providers should check the in-basket at least twice over the next week. Most providers (68%) felt that individuals should be responsible for answering their own documentation queries. 41% felt that providers should be responsible for their own results, and 56% felt they could follow-up on results for off-service colleagues only if that colleague signed the follow-up out to them.
Conclusions: Conclusions: These results show variability in practice and expectations for following up on lab results and documentation queries. Providers were split on whether their clinical work should stop when their time on service ends or if they should be expected to check the EHR after completion of service. Practices should consider prioritizing a standardized mechanism for managing follow-ups to avoid missing key lab tests and to reduce workload burdens for clinicians both on and off-service.