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%, Pā€‰<ā€‰.001; and 82% versus 70%, Pā€‰=ā€‰.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.

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Citation

Published Version (Please cite this version)

10.4300/JGME-D-16-00460.1

Publication Info

Boggan, Joel C, Aparna Swaminathan, Samantha Thomas, David L Simel, Aimee K Zaas and Jonathan G Bae (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. 195ā€“200. 10.4300/JGME-D-16-00460.1 Retrieved from https://hdl.handle.net/10161/19779.

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Scholars@Duke

Boggan

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 Department of Medicine and the Program Director for the Duke University Hospital CRQS.

As Associate Program Director for Quality Improvement and Patient Safety in the Duke Internal Medicine Residency Program, I oversee QI and safety education and projects for our residents and help co-lead our Residency Patient Safety and Quality Council. Additionally, I supervise housestaff and students on our general medicine wards, precept housestaff evidence-based medicine resident reports, and serve as a small group leader for our second-year medical student Clinical Skills Course. Finally, I lead our Innovation Sciences committee as part of the ongoing School of Medicine Curriculum Innovation Initiative.

Swaminathan

Aparna Swaminathan

Assistant Professor of Medicine
Thomas

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 of interest include training of collaborative biostatisticians, modeling of non-linear associations, and application of partitioning analyses to identify homogeneous patient groups.

Simel

David Lee Simel

Professor Emeritus of Medicine

Chief, Medical Service, Durham Veterans Affairs Medical Center

Appropriateness 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

Zaas

Aimee Kirsch Zaas

Professor of Medicine

Medical education
Genomic applications for diagnosis of infectious diseases
Genomic applications for prediction of infectious diseases

Bae

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.


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