Improving Timely Resident Follow-Up and Communication of Results in Ambulatory Clinics Utilizing a Web-Based Audit and Feedback Module.
Abstract
Failure to follow up and communicate test results to patients in outpatient settings
may lead to diagnostic and therapeutic delays. Residents are less likely than attending
physicians to report results to patients, and may face additional barriers to reporting,
given competing clinical responsibilities.This study aimed to improve the rates of
communicating test results to patients in resident ambulatory clinics.We performed
an internal medicine, residency-wide, pre- and postintervention, quality improvement
project using audit and feedback. Residents performed audits of ambulatory patients
requiring laboratory or radiologic testing by means of a shared online interface.
The intervention consisted of an educational module viewed with initial audits, development
of a personalized improvement plan after Phase 1, and repeated real-time feedback
of individual relative performance compared at clinic and program levels. Outcomes
included results communicated within 14 days and prespecified "significant" results
communicated within 72 hours.A total of 76 of 86 eligible residents (88%) reviewed
1713 individual ambulatory patients' charts in Phase 1, and 73 residents (85%) reviewed
1509 charts in Phase 2. Follow-up rates were higher in Phase 2 than Phase 1 for communicating
results within 14 days and significant results within 72 hours (85% versus 78%, P < .001;
and 82% versus 70%, P = .002, respectively). Communication of "significant" results
was more likely to occur via telephone, compared with communication of nonsignificant
results.Participation in a shared audit and feedback quality improvement project can
improve rates of resident follow-up and communication of results, although communication
gaps remained.
Type
Journal articleSubject
HumansMedical Records
Follow-Up Studies
Communication
Internal Medicine
Time Factors
Internship and Residency
Feedback
Internet
Physicians
Ambulatory Care Facilities
Medical Audit
Female
Male
Permalink
https://hdl.handle.net/10161/19779Published Version (Please cite this version)
10.4300/JGME-D-16-00460.1Publication Info
Boggan, Joel C; Swaminathan, Aparna; Thomas, Samantha; Simel, David L; Zaas, Aimee
K; & Bae, Jonathan G (2017). Improving Timely Resident Follow-Up and Communication of Results in Ambulatory Clinics
Utilizing a Web-Based Audit and Feedback Module. Journal of Graduate Medical Education, 9(2). pp. 195-200. 10.4300/JGME-D-16-00460.1. Retrieved from https://hdl.handle.net/10161/19779.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Jonathan Gregory Bae
Associate Professor of Medicine
Patient safety and quality improvement, hospital based performance improvement, care
transitions and hospital readmissions, general internal medicine hospital care, resident
and medical student education.
Joel Boggan
Associate Professor of Medicine
I am a hospital medicine physician interested in quality improvement, patient safety,
and medical education across the UME, GME, and CME environments. My current QI and
research projects include work on readmissions, inpatient ORYX and patient experience
measures, clinical documentation improvement, medication reconciliation, and appropriate
utilization of inpatient resources. Alongside this work, I serve as the lead mentor
for our Durham VA Chief Resident in Quality and Safety within the Depart
David Lee Simel
Professor of Medicine
Chief, Medical Service, Durham Veterans Affairs Medical CenterAppropriateness of diagnostic
test use, including not just traditional laboratory and radiographic tests, but also
the clinical examination. Editor of the "Rational Clinical Examination Series" published
in the Journal of the American Medical Association. Metaanalysis of diagnostic test
studies
Aparna Swaminathan
Assistant Professor of Medicine
Samantha Thomas
Biostatistician, Principal
Samantha is the manager of the Duke Cancer Institute (DCI) Biostatistics Shared Resource.
Collaboratively, she primarily works with physicians in DCI, specifically in research
of Endocrine Neoplasia and Breast Cancer. She is also the director of the Biostatistics,
Epidemiology, Research, and Design Methods (BERD) Core Training and Internship Program
(BCTIP). Her professional experience involves study design, analysis, and reporting
of clinical trials and observational studies. Her specific areas
Aimee Kirsch Zaas
Professor of Medicine
Medical education Genomic applications for diagnosis of infectious diseases Genomic
applications for prediction of infectious diseases
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