Failure to report or act on lab results is a common failure leading to medical malpractice litigation. Never assume your policies and procedures are adequate to avoid this risk.
- A formal tracking mechanism is a must.
- The system should ensure that results are reviewed by a physician and reported to the patient.
- “No news is good news” is a risky policy when reporting lab results.
Errors related to poor handling of lab results are a well-known patient safety risk, but risk managers should not assume their physicians and staff follow the proper policies and procedures to avoid liability, says Darrell Ranum, vice president of patient safety and risk management with The Doctors Company, a malpractice insurer based in Napa, CA.
Any healthcare provider should put procedures in place for monitoring lab results, not just to ensure that they are received but also that they are reviewed by the physician and reported to the patient, Ranum says.
Formal tracking mechanisms are reducing the incidence of malpractice litigation related to lab results, Ranum says. But errors still occur. (See the story in this issue for data on how lab results lead to malpractice litigation.)
Liability risks exist from the first moment a test is ordered. Ranum recalls a case in which a physician failed to order the proper genetic testing for a pregnant woman, resulting in the parents assuming the child was free of a disease that ran in the family because the results for the tests that were performed came back normal. The child did have the disease and the family received an award to cover ongoing medical costs.
Lab results often slip through the cracks in the most unexpected ways, Ranum says. He remembers one case in which a patient ordered a PSA test and the lab reported slightly abnormal results. The test results got lost within the paper chart and the physician told the patient that the results had not been received yet, but the office would call when they came in.
“The physician had no tracking mechanism and the result was already there, so there was no result to come in and trigger the office to notify the patient,” Ranum says. “A year later, the patient came in and had an aggressive form of prostate cancer. They later were able to track down the result that should have prompted action the first time the test was performed.”
Another risk is when physicians do not check lab results or report them to the patient until the patient’s follow-up visit, Ranum says. Sometimes, the patient never returns, and the test result is never reported to the patient.
“Some physicians tell patients, ‘if you don’t hear from me, no news is good news’ with lab results. That’s a risky policy to follow,” he says. “Now, more physicians are adopting the policy of telling the patient they will call the patient within two weeks with the results, but if you don’t hear from us by then, please call us. They’re building in some redundancy if the patient does not receive the report.”
The frequency of a payout in cases involving labs is higher than normal because it often is simple to prove that the patient was harmed by the error, Ranum says. The payouts can be substantial, particularly with tests to detect cancer and other serious diseases, he notes. Those cases easily can run into the hundreds of thousands of dollars and sometimes much more, he says. (See the story in this issue for research suggesting benefits of reporting lab results to a physician’s smartphone.)
Formal tracking mechanisms can be instituted at almost no cost, Ranum notes. Physicians and staff sometimes resist the change in daily practice and the formality of tracking, but they usually find themselves feeling much more confident in the system once it is adopted, he says.
“This is something that needs more attention. When we conduct risk surveys of the physicians and hospitals we insure, we still find institutions that do not have a formal tracking mechanism, or it’s an extremely loose mechanism where things can get lost,” Ranum says. “Staff will tell us that they lose results and have to call the patient back in to do the test again, but those are the fortunate ones who recognize that they lost the result. This needs to be high on the priority list.”
- Darrell Ranum, Vice President of Patient Safety and Risk Management, The Doctors Company, Napa, CA. Email: email@example.com.