Abstract 465 Medical Informatics Platform, Saturday, 5/1

BACKGROUND: Results of some laboratory tests for emergency department (ED) patients return hours to days after the patient is discharged. Most EDs do not have a system to insure complete follow-up for all late-arriving lab results. Inadequate follow-up for late-arriving lab results poses medical and legal risks. We have developed, but not yet implemented, a computerized system called the Automated Late-Arriving Results Monitoring System (ALARMS). ALARMS scans the hospital's laboratory and ED registration databases to identify all abnormal lab results for ED patients that return after the patient's time of discharge. ALARMS adds these results to an electronic log which is reviewed daily by a designated ED physician. ALARMS prompts the user to electronically document a plan for follow-up of the abnormal lab value. OBJECTIVES: To determine the potential impact of ALARMS by assessing our ED's current quality of documented follow-up of late-arriving lab results. METHODS: We applied ALARMS retrospectively, to find all abnormal late-arriving lab results returning between 5/1/96 and 4/30/98 for ED patients for the following 3 tests: (1) Serum lead levels, (2) Chlamydia cultures, or (3) Urine pregnancy tests. Medical records were reviewed for evidence of documentation of appropriate follow-up of the lab result. Follow-up was considered appropriate only if a clinician noted the abnormal result and documented a plan for follow-up within 1 week of the time the result became available. The medical record was also reviewed for any evidence of complications attributable to delayed or inadequate follow-up of these results. RESULTS: Over the 2 year study period, there were 18 abnormally elevated lead levels (> 10 mcg/dL). No appropriate follow-up was documented for 6 (33%) of these cases. Lead levels for patients without documented follow-up ranged from 11 to 28 mcg/dL. There were 4 late-arriving positive pregnancy tests. No appropriate follow-up was documented for 3 (75%) of these cases. There were 39 late-arriving positive Chlamydia cultures. No appropriate follow-up was documented for 23 (59%) of the cases. Of these 23 cases, 7 had empiric therapy for Chlamydia at the initial ED visit. For the other 16 cases (41% of all positive Chlamydia cultures), there is no documentation that the infection was treated. One possible complication of inadequate follow-up was noted. A 19 year-old female had a cervical culture positive for Chlamydia. There is no documentation of follow-up for this result. Six weeks later, the patient returned to the ED and was diagnosed with pelvic inflammatory disease. CONCLUSIONS: Our current system of documented follow-up for late-arriving lab results has deficiencies. ALARMS, a computerized system of alerts for ED physicians, could substantially improve documented follow-up of late-arriving lab results in the emergency department.