It is common in many U.S. hospitals to send patients home before all microbiology culture results are ready. This helps free up hospital beds and lowers costs. But it can also cause safety issues because 2% to 11% of these test results need changes in treatment once they come back.
Research by Roy and others found that about 41% of patients leave the hospital with at least one pending microbiology test. Of these, 9.4% need action based on the result. Other studies show similar numbers. Around 11% of positive cultures finalized after discharge need treatment changes, especially for urine and wound infections. Without good follow-up, patients might get delayed or wrong treatment.
One big problem is that many pending test results are not written down properly in hospital discharge summaries. Studies found only 11% to 18% of these results are recorded at discharge. This is worse for older patients or those sent to subacute care facilities. When documentation is poor, no one knows who should follow up. Roy’s study showed that in over 60% of cases, doctors did not know results were still pending. This lack of communication can lead to more emergency visits, readmissions, and worse patient outcomes.
To fix these issues, some hospitals in the U.S. started using electronic health record (EHR) alert systems. One study from 2009 to 2010 tested an automated email system that told doctors about positive microbiology results after patients left the hospital.
The study showed that follow-up within three days happened in 28% of cases with alerts. Without alerts, it was just 13%. This was a 15% improvement. Also, 58% of doctors said the alerts changed their treatment plans and 56% said the results required urgent action. Still, the overall follow-up rate was low, so alerts help but don’t solve the whole problem.
Two U.S. hospitals have used alert systems with good results.
Emory University Hospitals started the aftER Care program in 2008. It collects all pending test results for discharged patients into one list providers review each shift. If patients cannot be reached by phone, the system sends certified mail to communicate. This closed 99.8% of pending tests, much better than before when done by hand.
Antionette Ward, a nurse practitioner at Emory, said this system made managing pending results easier. It replaced paper systems that risked missing results.
Brigham and Women’s Hospital created the Longitudinal Medical Record Results Manager. It merges patient history, lab results, and medications. The system sends daily reminders for unacknowledged critical results. It also lets clinicians delegate follow-up tasks. A small trial showed this system more than doubled documented follow-ups for post-discharge microbiology cultures.
There are still problems with automated alerts. One is alert fatigue, which happens when doctors get too many notifications, including ones that are not important. This can make them ignore important alerts. Another problem is that healthcare data is often stored in separate places. Lab information and pharmacy records might not connect well in the electronic medical record. This makes it hard to see all relevant data for care decisions like adjusting antibiotics based on culture results.
Lab specialists who understand both science and information systems can help design alert systems that reduce fatigue and improve communication between labs and clinical teams.
Artificial intelligence (AI) and workflow automation can help manage pending microbiology results better after discharge. Systems like those at Emory and Brigham can use AI to prioritize alerts. AI looks at how urgent the test results are, patient risks, and other data.
For example, AI could check a patient’s entire health record, including other illnesses and past antibiotic responses. It can then decide which pending results need quick attention and which can wait. This helps cut down on alert fatigue by sending only urgent alerts to doctors. Less urgent cases might be handled by care coordinators or pharmacists.
Workflow automation assigns clear follow-up tasks within care teams. It makes task lists and sends needed messages to patients or outpatient providers. Automated tools can add pending test info into discharge summaries so that primary care doctors or facility staff get accurate information.
Hospitals using these systems usually include IT staff, pharmacists, lab experts, and clinicians to make sure the process fits well into daily routines.
Pharmacist-led programs, along with electronic alerts, have helped improve patient care. Studies at Dartmouth-Hitchcock and other places found pharmacists reviewing final microbiology results within 72 hours after discharge helped adjust treatment in 29% to 100% of cases. Coordinated programs help with better antibiotic prescribing. They also reduce resistance and make sure patients get suitable treatment based on final results.
These programs are especially important for patients at high risk, like older adults discharged to subacute facilities. These patients often face broken communication and less outpatient care.
IT leaders should work with clinical staff to prevent alert overload. Using tiered alert systems—where critical results cause immediate alerts but less urgent notices are grouped or assigned to others—can lower fatigue and improve response.
By adding automated alert systems that use AI and good workflow automation, hospitals and clinics in the United States can help doctors know about pending microbiology results faster. This improves follow-up rates and lowers risks from missed or late test results after patients go home. These approaches, supported by teamwork and clear processes, play an important role in patient safety and quality care in healthcare settings.
The primary aim is to improve the follow-up of microbiology results that return after patients are discharged from the hospital.
It addresses the failure to follow up on pending microbiology results that can delay diagnosis and treatment of infections and increase patient risk.
A cluster randomized controlled trial involving inpatient and outpatient physicians at a large academic hospital.
The primary outcome was documented follow-up of results within 3 days, while secondary outcomes included physician awareness and assessment of urgency.
The system improved documented follow-up to 28% in the intervention group compared to 13% in the control group.
A significant majority (96%) of physicians preferred alerts for current or broader scenarios regarding test results.
Yes, 58% of physicians felt the results changed their clinical assessments and plans.
39% of inpatient physician respondents were aware of the results prior to receiving the alerts.
The study suggests that the alerting system may be expanded in the future as it was well received.
Despite improvements, the overall proportion of follow-up on important microbiology results remained low.
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