Failure to communicate test results adds risks
Because clinical evaluation often depends on diagnostic tests, diagnostic physicians have a responsibility to notify referring clinicians when test results reveal urgent or unexpected findings. According to a report in the Journal of the American College of Radiology (JACR), the rapid growth of diagnostic testing appears to be placing physicians at greater risk for medical malpractice claims for test communication failures.
During the past decade, clinicians have ordered dramatically greater numbers of diagnostic examinations, according to the article by Brian D. Gale, MD, MBA, assistant professor of radiology at SUNY Downstate Medical Center in Brooklyn, and colleagues.1 They also cite a study demonstrating that between 1996 and 2003, malpractice payments related to diagnosis increased by about 40%.
Contributing factors in malpractice cases associated with communication failures include, for example, failure of physicians and patients to receive results, delays in report findings, and lengthy turnaround time, the report notes.
Using data from the National Practitioner Data Bank (NPDB), the authors found that the total indemnity payout across all medical specialties for U.S. claims related to the three types of communication failures they studied increased from $21.7 million in 1991 to $91 million in 2010. Linear regression analysis of data from 1991 to 2009 indicated that communications-related claims payments increased at the national level by an average of $4.67 million annually.
Over the same period, NPDB data showed that communication failure awards accounted for an increasing proportion of total U.S. malpractice awards for all providers. The proportion increased by a factor of 1.7, from 0.93% in 1991 to 2.31% in 2009.
Gale and his co-authors write that the advent of semi-automated critical test result management systems might improve notification reliability, improve work flow and patient safety, and, when necessary, provide legal documentation. They recommend that when reportable test results arise, healthcare organizations need clear policies that define the responsibility of reporting and referring providers to ensure patient follow-up.
1. Gale BD, Bissett-Siegel DP, Davidson SJ, et al. Failure to notify reportable test results: Significance in medical malpractice. J Amer Coll Radiology 2011; 8:776-779.