Preventing lost-to-follow up diagnostic imaging in ambulatory care: evaluation of an electronic notification tool

• Published in: BMJ open quality 2023-07, Vol.12 (3), p.e002334
• Main Authors: Dadlez, Nina M, Le Clair, Amy M, Wasima, Syeda, Mayer, Nicole, Harvey, William F, Roberts, Kari, Mazzullo, John, Lominac, Eric, Koethe, Benjamin C, Weingart, Saul N
• Format: Article
• Language: English
• Subjects: Ambulatory Care; Delayed Diagnosis; Diagnostic Imaging; Diagnostic tests; Electronic health records; Humans; Lost to Follow-Up; Medical diagnosis; Medical errors; Medical screening; Order entry; Original Research; Patients; Pediatrics; Physicians; Primary care; Project evaluation; Quality improvement; Quality of care; Regression analysis
• ISSN: 2399-6641; 2399-6641
• DOI: 10.1136/bmjoq-2023-002334

Missed or cancelled imaging tests may be invisible to the ordering clinician and result in diagnostic delay. We developed an outpatient results notification tool (ORNT) to alert physicians of patients' missed radiology studies. Randomised controlled evaluation of a quality improvement intervention. 23 primary care and subspecialty ambulatory clinics at an urban academic medical centre. 276 physicians randomised to intervention or usual care. 90-day test completion of missed imaging tests. We included 3675 radiology tests in our analysis: 1769 ordered in the intervention group and 1906 in the usual care group. A higher per cent of studies were completed for intervention compared with usual care groups in CT (20.7% vs 15.3%, p=0.06), general radiology (19.6% vs 12.0%, p=0.02) and, in aggregate, across all modalities (18.1% vs 16.1%, p=0.03). In the multivariable regression model adjusting for sex, age and insurance type and accounting for clustering with random effects at the level of the physician, the intervention group had a 36% greater odds of test completion than the usual care group (OR: 1.36 (1.097-1.682), p=0.005). In the Cox regression model, patients in the intervention group were 1.32 times more likely to complete their test in a timely fashion (HR: 1.32 (1.10-1.58), p=0.003). An electronic alert that notified the responsible clinician of a missed imaging test ordered in an ambulatory clinic reduced the number of incomplete tests at 90 days. Further study of the obstacles to completing recommended diagnostic testing may allow for the development of better tools to support busy clinicians and their patients and reduce the risk of diagnostic delays.