Communicating Test results
Communicating results in a timely fashion and answering messages from our patients.
How do we communicate an abnormal biopsy or an abnormal X-ray to our patients in a timely, efficient manner?
Getting an X-ray and waiting several days to get the results is very common practice. So, if you are a female patient who felt a lump on breast exam and go to have a mammogram, wouldn’t you want to know the results right after you have the test done? Is it ok to keep someone waiting for hours, maybe days, agonizing over the results?
I could say the same for so many other tests and procedures we performed and sometimes forget that for that person it means everything to have a quick response.
We have the technology to know these results almost immediately, especially for imaging studies. How can we improve this process of communicating timely with our patients?
This is a great subject where patient’s expectations and hospital routines are not aligned. Some hospitals have tried to address this issue by building one-day clinics. Breast is one such example where in a single day they can perform the mammogram, the biopsy and even the cytology study and provide a same day orientation to the patient. It needs restructuring but has been very well received. I know also of one-stop clinics for thyroid nodules
Thank you for the feedback
What are the current barriers to reducing communication time? As you say, the technology is there to have results almost instantly.
I agree that one stop clinics are a great way to reduce the “waiting” – and patient’s expectations are managed very effectively.
An issue I have experienced in the past has been the method of communicating results. Historically this has been done by post, adding days to the wait. The results also sometimes went from hospital physician, to primary care, then the patient contacted to make an appointment to come in for their results, often adding another few days to the wait (at the same time the patient knowing the results were likely bad news as they had been called into the doctors surgery…). How can we use modern day technology better? Although it wouldn’t be appropriate for patients to receive instant results by email, without some form of physician involvement, how can medical professionals utilise technology better? I have seen effective use of central systems where different agencies are able to access a central system for results. This cuts down the “chasing of results” scenario, and enables communication to the patient quicker.
I agree that given today’s technology, same day results should be possible now, not a thing of the future!
Thank you!
Often, the challenge is not getting results quickly, it is translating those results in a meaningful way to the patient. A “normal” result is clear, but many times, what an imaging report or a lab result communicates to the patient can be confusing and cause more anxiety. In my world, I am often communicating imaging results of the spine. The MRI report may show pages of degenerative changes, that mean very little clinically. It takes a clinician to review the imaging, understanding the context of the patient’s symptoms, to determine what is relevant on the MRI. I don’t actually like when the patient sees a report before I can discuss this with them. There is actual literature that shows low back pain patients have worse outcomes when they know their MRI results.
So, what has been helpful is up front education, before the test is even obtained. I spend a lot of time when ordering the MRI, explaining to the patient that I expect to see multiple degenerative changes, and that this is normal. Now, as soon as the MRI is complete, I review the images, and unless there is something concerning, my nurse will call with results. The turn-around time is pretty quick, and I have prevented the typical concern/anxiety about the “severe degenerative disc disease” that is written on the patient’s MRI report.
@SpineDoc, thanks for the feedback and I see your points. About three years ago we started sharing labs and X-ray results automatically 24 hours after they were performed and we’ve had an overwhelming positive response. It has actually help in some cases where doctors missed an interpretation and the patients point it out to the providers. Just the other day speaking with a media person that was covering an event at our organization, I was explaining how the patient portal works and the fact that we automatically release results within 24 hours. That person, thinking out loud, stated: it makes sense, why wouldn’t doctors across the board want this? The patients (consumers) own their records and they are entitled to get the results immediately, or at least at a recent time from when they were done.
Patients understand and expect an explanation of the results from the physicians and they come prepare with questions based on what the tests revealed. Can the terms be confusing to them? Probably, but that’s when we step in with our expertise and simplify for them.
I believe the solution is simple but the department leadership must be willing to adopt a patient-centered culture of real time delivery of results. Most test results, including radiology and pathology, can be delivered in minutes to hours. The mammogram is a great example. The last time I had a mammogram, I had to wait over a week for the results even though the radiologist reviewed the scan while I was in the mammogram suite. In the US, fear of litigation may be driving some of these practices, thus it is up to leadership to decide communication with patients, their comfort and peace of mind are the highest priorities.
I agree. Thank you Lisa!
We have started calling patients with results for procedures such as mammograms and other radiology exams. The mammos are called within the same day and many within the first hour after exam is completed. This has been a big customer satisfaction initiative our women’s center has initiated. Satisfaction scores have increased tremendously but the main reason of doing this is quality of care.
I agree Paul! Thanks for the feedback.
The earlier the results be communicated to the patients the better to avoid any anxiety. It should be done in the most honest, respectful and compassionate way. The patient has the right to know in detail the results and they should be guided and given all the options that they have.
Thank you for the feedback!
I think it is a combination of building in time (in the schedule) for providers and staff to review and discuss results with patients as well as leveraging technology for benign results.
My concern with an auto-push of results using technology would be the potential lack of personalization. Patients may feel they are just a number and ask themselves “did my provider really review these results?” “What does this mean?” It does not give the patient the ability to ask questions. It dehumanizes the process and relationship and potentially diminishes compliance. Also, many older adults may lack the access or technologic savvy-ness to use a portal or receive electronic results.
How do you effectively communicate complicated results and incidental-omas? I fear confusion, worry and frustration with results that may be received electronically and misinterpreted by a lay person. The situation would have been avoided if the provider could explain, answer questions and reassure.
On the flip side, we are a “on demand” generation that doesn’t want to wait and I totally agree I would want my mammo results without having to wait a week. There has to be a middle ground.
Idea: Delivering results electronically in real time with canned explanations on how a lay person can interpret with an opt in/out follow up visit for in-person discussion. So if the result was completely negative and the patient did not have any follow up questions, they could opt out, saving time and resources. However, the patient that prefers face to face interactions or had questions, they still can schedule a follow up. I believe this would satisfy both worlds.
Thanks for the feedback!