Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Endoscopic Endonasal Approach to the Orbit.

BACKGROUND

Failure to follow up on test results pending at discharge (TPAD) is a well-documented patient safety issue, affecting 20% to 61% of hospitalized patients. At our institution, TPAD management practices varied, and no standardized process existed.

OBJECTIVE

To increase the percentage of TPAD managed within 36 hours of resulting for patients discharged by the pediatric hospital medicine (PHM) service from 53% to 95% in 3 months and sustain improvement over 9 additional months.

METHODS

We used the Model for Improvement methodology. All TPAD for PHM patients were routed to a shared electronic health record in-basket. We delegated daily result management to the admitting physician, with defined timing expectations and backup coverage. TPAD were categorized into 4 groups based on result type, urgency, and impact on care to help standardize management. Newly created documentation templates, instructional guides, and written agreements with subspecialists supported workflow implementation. Project measures were analyzed using statistical process control charts and differences between groups using appropriate statistical testing.

RESULTS

Of 5912 TPAD (1307 baseline; 4605 postintervention), results managed within 36 hours increased from a mean of 53% to 96%. Mean time to manage TPAD decreased from 195.4 hours to 11.6 hours. No disparities in timely result management were observed by race, ethnicity, language, or insurance. Per self-report, physicians spent an average of 10 minutes per shift on result management. Postintervention surveys showed high clarity, physician wellness, and high satisfaction.

CONCLUSIONS

This workflow successfully improved TPAD management, with high physician satisfaction. Next steps include improving documentation, quarterly audits, and involving trainees.