Publication Date
10-1-2020
Journal
Applied Clinical Informatics Journal
DOI
10.1055/s-0040-1716537
PMID
33086395
PMCID
PMC7577780
PubMedCentral® Posted Date
10-21-2020
PubMedCentral® Full Text Version
Post-Print
Published Open-Access
yes
Keywords
Electronic Health Records, Follow-Up Studies, Humans, Outpatients, contextual inquiry, fault tree analysis, abnormal laboratory follow-up, human factors, patient safety
Abstract
OBJECTIVE: This study demonstrates application of human factors methods for understanding causes for lack of timely follow-up of abnormal test results ("missed results") in outpatient settings.
METHODS: We identified 30 cases of missed test results by querying electronic health record data, developed a critical decision method (CDM)-based interview guide to understand decision-making processes, and interviewed physicians who ordered these tests. We analyzed transcribed responses using a contextual inquiry (CI)-based methodology to identify contextual factors contributing to missed results. We then developed a CI-based flow model and conducted a fault tree analysis (FTA) to identify hierarchical relationships between factors that delayed action.
RESULTS: The flow model highlighted barriers in information flow and decision making, and the hierarchical model identified relationships between contributing factors for delayed action. Key findings including underdeveloped methods to track follow-up, as well as mismatches, in communication channels, timeframes, and expectations between patients and physicians.
CONCLUSION: This case report illustrates how human factors-based approaches can enable analysis of contributing factors that lead to missed results, thus informing development of preventive strategies to address them.
Comments
Associated Data