346 - Increasing Communication of Laboratory Results with Families in a Pediatric Outpatient Primary Care Setting: A Quality Improvement Initiative

Poster Number: 346
Publication Number: 346.345

Hannah L. Tredway, New York Presbyterian Columbia, New York, NY, United States; Connie Kostacos, Columbia University Vagelos College of Physicians and Surgeons, Cos Cob, CT, United States; Mariellen Lane, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States

Background: Acknowledgment of laboratory tests in a timely fashion is a vital aspect of high-quality pediatric care and can be challenging in a practice with rotating trainees. Delays in reviewing outpatient test results and notifying families can significantly impact patient safety and satisfaction, and have been shown lead to diagnosis-related malpractice cases. Prior studies have identified the need to improve test result management and office workflow efficiency to improve patient and practitioner satisfaction. Quality improvement (QI) techniques to improve clinic workflow and decrease time to patient notification of test results have thus far been lacking.

Objective: This resident-let QI project aimed to increase the percentage of test results communicated to patients, both normal and abnormal, from a baseline of 48% to a goal of 90% between October 2020 and June 2021.

Design/Methods: A collaborative team of pediatric residents, faculty, nurses, and office administrators met to identify current workflows for communication of test results and barriers to timely communication. Based on the identified barriers, a key driver diagram (Figure 1) was developed and several interventions were implemented using a Plan-Do-Study-Act model. A didactic presentation was first created to educate residents about institutional policies. Provider consensus based on institutional policies led to the creation of a workflow for laboratory acknowledgement, communication, and documentation. This was followed by an effort to increase patient enrollment in the electronic medical chart, through which providers can more easily communicate with families. Other interventions included monthly physician report cards and standardized phrases for expedited communication of normal and abnormal test results.

Results: Baseline provider-reported data revealed that normal results were communicated less than 5% of the time by 45% of providers, while abnormal results were communicated greater than 75% of the time. Over the study period, the percentage of normal and abnormal labs reviewed, documented, and communicated to patients increased to approximately 85% at peak success, as demonstrated in the run chart (Figure 2).Conclusion(s): This resident-led QI project addressed barriers to timely laboratory acknowledgement and showed that communication and documentation rates can be improved by developing a standardized workflow based on identified barriers and enhancements in the electronic medical record. Further work needs to be done to expand the workflow beyond physician providers within the practice and sustain the enhanced communication practices.
Key Driver DiagramKey Driver.jpegThis tool displays the primary aim of the project (left), as well as primary drivers (center) or system factors affecting the project outcome. The interventions that were conducted to address each primary driver are also shown (right).
Run ChartRun Chart.jpegPercentage of normal and abnormal lab values communicated with patients and families and documented between October 2020 and April 2021. Baseline rate of communication and documentation was 48%. Goal rate of communication and documentation was 90%. Specific interventions are outlined.