What happens when critical lab or radiology results are not communicated to the doctor

 

Improved hospital staff communication is a National Patient Safety Goal for 2017

 
November 1, 2017

I focus my Houston, Texas-based law practice on representing patients and family members in medical malpractice cases. This gives me an opportunity to see trends in medical errors generally, as well as bad outcomes that happen over and over again at particular hospitals.

Another organization that has the unique vantage point for medical errors is the Joint Commission, which is a major accrediting organization for hospitals and healthcare facilities. Each year, the Joint Commission issues a list of several National Patient Safety Goals, based on its analysis of common medical errors and recommendations on how to reduce them.

Timely getting test results to the right healthcare provider

In 2017, National Patient Safety Goal 02.03.01 mandated improvement of staff communication, requiring hospitals to implement policies and procedures to, “Get important test results to the right person on time.”

I have handled tons of cases where communication errors of critical laboratory values or radiology studies caused serious injuries or death to patients. Unfortunately, with the advent of electronic medical records, it seems that these errors are becoming even more commonplace. Perhaps this had something to do with the Joint Commission’s decision to make staff communication a National Patient Safety Goal in 2017.

Reviewing physician orders for appropriate urgency

When Painter Law Firm investigates a medical malpractice case, we review all relevant lab and radiology studies to see if the physician ordered them with sufficient urgency. Generally speaking, there are two categories for orders. The first category is called stat, which means as soon as possible. The second category is routine, which basically means when the lab or radiology departments can reasonably perform the study. Some hospitals have an additional category called super-stat, which means immediately. All hospitals should have policies and procedures that define response times for each type of order.

I am working on a case now in which our client had a lumbar fusion surgery and on the post-operative day started showing signs of neurological issues. He could not urinate, he was numb from the waist down, and he could not move his feet normally. The nursing staff eventually notified the surgeon of some of these findings, and the surgeon responded by ordering a routine MRI. When the surgeon saw the patient, about seven hours later, the routine MRI had not been performed. Our expert spine surgeon reviewed the records and shared his opinion that the standard of care requires a stat MRI under the circumstances, because there could be a hematoma or other compressive lesion causing damage to the spinal cord. An MRI would verify this and would lead to emergency surgery to remove the compression.

Reviewing whether abnormal and critical test results are properly reported

Another type of error that we commonly see in medical negligence cases directly relates to the 2017 National Patient Safety Goal on improving staff communication. In these cases, a physician gave an appropriate order for lab work or radiology study, but abnormal results were not appropriately communicated to the ordering physician.

When it comes to lab work, each hospital or laboratory has certain ranges for each test that are programmed into its equipment. If the lab value falls within the normal reference range, the number will be recorded, but not flagged. If it is above or below the normal reference range, it will be flagged as abnormal. At certain levels above or below the normal reference range, the result will be flagged as critical. This is all done electronically.

When there is a critical lab value, the standard of care requires the lab personnel to communicate the information to the nursing staff. The standard care then requires the nursing staff to inform the ordering physician immediately, and to advocate for appropriate care. Unfortunately, all too often, critical lab values are returned electronically, in the patient’s electronic medical record, with no direct human-to-human communication. This can cause urgent, critical information to be left buried in the medical records, until a nurse has time to look it up. Sometimes this does not occur until shift change.

As for radiology studies, interpretation is not yet computerized. In other words, a highly-trained radiologist has to review the scans and form an impression and interpretation. The standard of care requires radiologists to report critical findings to the ordering physician immediately. After doing so, the radiologists can prepare a written report of the findings, which will go into the medical record.

Some time ago, I handled the case where a neuroradiologist interpreted a brain MRI as showing such significant swelling that there was “impending uncal herniation.” In lay terms, this means that the patient’s brain was in such danger from swelling that it was about to squeeze out the back of her skull, which would cause immediate death. While the neuroradiologist made the correct interpretation, he only wrote it in a report and failed to call the ordering physician, which led to a needless delay in emergency treatment of the patient.

What you can do

You can help improve patient safety by being an active patient or family member. By this, I mean that you should keep a healthcare journal listing tests that have been ordered, the date and time that they were ordered, the reasons that they are being ordered, and the urgency of each test (i.e., stat or routine). This information will allow you to have more focused dialogue with your nurses, doctors, and healthcare providers, and we and added layer to make sure that things do not fall through the cracks.

If you or a loved one has been seriously injured as a result of a medical mistake, call the experienced medical malpractice attorneys at Painter Law Firm, in Houston, Texas, at 281-580-8000, for a free consultation about your potential case.

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Robert Painter is a former hospital administrator who is an attorney at Painter Law Firm PLLC, in Houston, Texas. He files medical negligence and wrongful death lawsuits on behalf of patients and their family members. He is a frequent writer and speaker on medical malpractice topics. He was previously editor-in-chief of The Houston Lawyer magazine, and currently serves on the editorial board of the Texas Bar Journal.

Robert Painter

Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.

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