Test Tracking and Follow-Up in the Office-Based Practice

Diagnostic testing is a key component of medical decision-making, but simply ordering a test is not enough. Timely follow-up on test results is crucial in providing safe, quality patient care. Delays or omissions can lead to missed or delayed diagnoses, adverse patient outcomes, and exposure to liability.

A Coverys analysis of closed medical malpractice claims data ranging from 2020 to 2024 found that diagnostic error was the second most frequent allegation, accounting for 27% of events and 42% of indemnity paid. Office-based settings accounted for the largest percentage of diagnostic-related claims, with 34% of events and 38% of indemnity paid. About half of those events were attributable, at least in part, to improper test management and follow-up. 

Timely follow-up on test results is both a patient safety issue and an ethical duty owed by practitioners to their patients. Patients have the right to receive their test results and an adequate explanation of those results in a timely fashion. Failure to provide this can cause unnecessary stress, decrease patient engagement, and, in some cases, contribute to poor health outcomes. Despite the dangers associated with untimely follow-up, the problem persists. 

Risk Recommendations:

Clear communication, dedicated follow-up teams, multidisciplinary collaboration, and automated tracking systems can help improve follow-up processes and minimize the impact delays have on patient care. Consider the following when evaluating test result management systems at your organization: 

• Evaluate processes. Review your organization’s policies and procedures regarding follow-up on test results. Ensure they provide specific guidance on: 
  • Using Computerized Physician Order Entry (CPOE) for test ordering whenever possible.
  • Assigning the person(s) responsible for following up on test results, including incidental findings.
  • Creating the timeline for following up on normal, abnormal, and critical test results.
  • Communicating normal, abnormal, and critical test results to patients and other care providers.
  • Establishing the process for follow-up on incidental findings.
  • Establishing the process for following up on test results when the ordering provider is away.
  • Documenting the receipt, review, communication, and follow-up of test results.
• Involve the patient. When ordering tests, set patient expectations regarding follow-up. Use plain language to educate the patient about the reason for the test, the possible results, and when they can expect the results. Involve the patient and their family in the treatment plan to ensure they understand the process. Empower patients to access their test results via the patient portal and inform them that they may access their results online before the practitioner has reviewed them. If follow-up on a test is necessary, use plain language to explain what follow-up is required and when it must be performed.
• Use visual aids. Visual aids, such as pictures or flow charts, can reinforce written or spoken communication and serve as reminders for patients after they leave the office. Consider creating a portable visual aid, such as a 4” x 6” card, which outlines steps in the testing process. Include what type of test was ordered, where they need to go for the test, when to expect results, steps for notifying the clinic/practitioner of results, clinic contact numbers for patients with concerns, and information about scheduling a follow-up call or office visit. 
• Assign review responsibilities. Assign dedicated staff members to review returned results several times daily to ensure that practitioners are promptly notified of test results requiring communication and follow-up. Ensure that the assigned staff operate within their scope of practice and possess the requisite skill, clinical judgment, and specialized expertise to competently perform the task. Work with your information technology (IT) department to implement automated patient reminders via text, email, or telephone to ensure patient awareness of the importance of follow-up.
• Leverage electronic health record (EHR) capabilities. Adherence to time deadlines and quick responses are crucial in the diagnostic process. A well-designed electronic tracking system can minimize patient care delays and alert practitioners to necessary changes in the treatment plan. Work with your IT department to design a robust system that can track, sort, and flag test results based on clinical relevance, ensuring that no abnormal or critical result goes unnoticed and that every patient receives the follow-up care they need. Provide the practitioner with a clear, easily understood, and accessible display of results. 
• Collaborate with other practitioners. Foster direct communication between radiologists, ordering physicians, and follow-up coordinators to ensure timely follow-up and reduce possible diagnostic and treatment referral delays. Implement regular case reviews to discuss pending follow-ups and resolve delays. A collaborative approach ensures that all healthcare professionals are working together to provide the best possible care for the patient.
• Monitor. Conduct regular risk assessments and audits to uncover workflow issues, workarounds, and other obstacles that can contribute to lapses in test result follow-up. Implement corrective action when necessary.

Lapses in test tracking and follow-up can result in diagnostic error, delays in necessary referrals and treatment, patient harm, and, in some cases, liability. Pairing well-designed test tracking and follow-up systems with well-crafted policies and procedures can enhance patient safety and reduce risk.