Risk management in emergency care with timely test results review

Severe staff shortages, a surge in Omicron cases and an ageing population have put our already-stretched emergency departments and health system under enormous pressure.

Due to the short lengths of stays, emergency department patients face particular risk of having test results pending at the time of discharge, with many hospitals acknowledging that they do not have reliable systems for managing such results.

Researchers led by Macquarie University conducted a before and after study in the emergency department of a 450-bed metropolitan teaching hospital in Australia to understand whether timely test results review with health information technology could help improve health outcomes for the patients.

Abnormal test results uncovered

The study demonstrated an alternative look at coordinating and driving test results review through leveraging technology. The aim was to improve the safety and effectiveness of the diagnostic process by increasing the rate of follow-up of results pending at hospital discharge.

As a part of the project, all radiology reports for discharged patients were reviewed for a one-month period before and after the implementation of the electronic result acknowledgement system to determine those that reported abnormal results and evidence of test result acknowledgement. All unacknowledged radiology results with an abnormal finding were assessed by an independent panel of two senior emergency physicians for clinical significance.

In the pre-implementation period, 1167 (70.6%) out of 1654 radiology reports were acknowledged by a clinician. For reports with abnormal results, 396 (71.6%) were acknowledged. Of 157 unacknowledged abnormal reports, 54 (34.4%) were identified as clinically significant and 27 (50%) were said to carry a moderate likelihood of patient morbidity if not followed up. In the ‘post’ period, all radiology reports were acknowledged, representing a 30.4% increase in acknowledgement rate, and a 28.4% increase for abnormal radiology results.

Active management of test results review

Australia has a reasonably well resourced and accessible healthcare system with a focus not just on throughput but also on quality of care but there are still parts of the system (particularly rural and regional areas) where there are significant delays for result reporting, such as radiology, and there are inadequate staff resources to follow up on all results, said A/Prof Richard Paoloni, Emergency Physician & Chief Medical Advisor, My Emergency Doctor and co-author of the abovementioned research paper titled Does health information technology improve acknowledgement of radiology results for discharged Emergency Department patients? A before and after study.

My Emergency Doctor is an emergency telemedicine provider led by Fellows of the Australasian College for Emergency Medicine. Founded by Sydney-based emergency physician, Dr Justin Bowra (MBBS FACEM CCPU) the organisation works alongside healthcare facilities and clinical staffs in metropolitan and regional hospitals, urgent care centres, multipurpose service centres, ambulance services, aged-care facilities and Primary Health Networks to provide a range of innovative healthcare solutions that can rapidly expand an emergency department’s capacity including virtual board rounds, access to real-time emergency physician consultations, as well as cost-effective and more timely review of a facility’s diagnostic test results.

A/Prof Paoloni said that the sooner the information is available, the sooner an accurate diagnosis and/or a specific treatment can be commenced. “In general, the sooner optimal treatment is commenced (at a less advanced stage of the illness) the lower the impact (morbidity) on the patient, and potentially lower mortality depending on the disease.”

Connected care

Technology can help improve accuracy as well as timeliness of result reporting and follow-up. Many tests that used to require manual processes are now performed by machines, with results available more quickly, said A/Prof Paoloni.

“Digitisation of result information allows rapid communication of information back to clinicians and, in some instances, to patients directly. Internet connectivity allows remote reporting of test results, particularly complex imaging, from anywhere in the world in real time.

“Medical devices, both implanted and non-invasive, can interact with mobile phones or other home base stations connected to the internet to provide real-time data to patients and their treating clinicians. This can include anything from blood glucose levels in diabetic patients to heart rhythm analyses in patients with defibrillators. Devices can be programmed to call an emergency ambulance if critical life threatening situations occur, including relaying the location of the patient based on GPS readings.

“Increasingly artificial intelligence will be used to augment, rather than replace, diagnostic accuracy. Many diagnostic interpretations in medical testing rely on pattern recognition, which is well within the scope of AI. Already there are programs undergoing real world clinical trials that provide AI interpretations of chest X-rays at the point of care, such as the emergency department, to identify potential abnormalities and alert the clinician to review that part of the X-ray more closely.”

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