Pending Lab Tests Getting Lost in Transfers

Although one-third of patients being transferred to a skilled nursing facility or rehab hospital have pending lab tests, only 11% of those patients' discharge summaries include this information, according to a study published in Journal of General Internal Medicine.

That omission makes it easier to not follow up on those test results, both in the acute and sub-acute setting, according to lead researcher Stacy E. Walz of the University of Wisconsin School of Medicine in Madison, WI.

Previous studies have demonstrated a high (41%) prevalence and poor discharge summary communication of pending lab tests at the time of hospital discharge for general medical patients. However, when it comes to patients discharged to sub-acute care facilities—including skilled nursing, rehabilitation, long-term care—little data is available. This is critical, as these patients “are often unable to advocate for themselves and have complex medical problems that need to be followed closely,” according to the authors.

In this retrospective cohort study, Walz and colleagues sought to determine the prevalence and nature of lab tests pending at hospital discharge and their inclusion within hospital discharge summaries, for common sub-acute care populations.

The investigators analyzed pending lab tests that were abstracted from the laboratory information system (LIS) and from discharge summaries of a group of 564 patients with stroke, hip fracture, and cancer who were discharged from a single large academic medical center to sub-acute care from 2003 to 2005. The lab tests were then grouped into 14 categories and compared; microbiology tests were sub-divided by culture type and number of days pending prior to discharge.

Of the sub-acute care patients, Walz and colleagues found that 32% (181 out of 564) were discharged with pending lab tests per the LIS; however, only 11% (20 out of 181) of discharge summaries documented these tests. Patients most often left the hospital with pending microbiology tests (83%), particularly blood and urine cultures, and reference lab tests (17%). However, 82% of patients’ pending urine cultures did not have 24-hour preliminary results, and 19% of patients’ pending blood cultures did not have 48-hour preliminary results available at the time of hospital discharge, they found.

Even after considering the availability of preliminary microbiology results, omissions of lab tests remained common in hospital discharge summaries, according to the authors. “Future studies should focus on improving the communication of pending lab tests at discharge and evaluating the impact that this improved communication has on patient outcomes,” they concluded.

To read the Journal of General Internal Medicine study, click here.

For more:

• Adequacy of hospital discharge summaries in documenting tests with pending results and outpatient follow-up providers (Journal of General Internal Medicine)
• Deficits in communication and information transfer between hospital-based and primary care physicians (JAMA)
• Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists (Journal of Hospitalist Medicine)