Presenter: Mukta Panda, MD
Institution: University of Tennessee, College of Medicine, Chattanooga Unit
Co-Authors: Ann Rybolt, MD; Margaret Calloway, RN; Roger Jones, MD
Introduction: Ambulatory primary care training in the continuity clinic is a mandatory requirement for internal medicine residents. This should include training in quality management in addition to academic and clinical medicine. The faculty at the multidisciplinary resident's continuity clinic developed a policy for tracking diagnostic tests and consults. The purpose is to:
Appropriate Tracking of Diagnostic Tests and Consults in a Multi-Disciplinary Resident Clinic: Role of a Tracking Log
- model an effective, safe, patient care system
- ensure appropriate tracking of tests and consults
- develop an educational tool for residents which would be reproducible at their own practices
- enhance training in system-based learning
Methods: A logbook was created and maintained for tracking which is done by the RN daily and reviewed by faculty monthly for completeness. The following information is recorded for each test:
- Entry Date
- Patient Name
- Medical Record Number
- Initials of person entering information
- Test or Consult Ordered
- Ordering Physician
- Date Test or Consult Scheduled
- Date Results Received
Action plan with date and action from ledger: (as follows)
- If results not received within one week of scheduled date, call for results
- If test not done or appointment not kept, call patient, determine reason for "no show" and make new entry if test rescheduled.
- Inform physician of abnormal results
- Attach results to chart, place in physicians' box
Initial Problems/Initial Solutions:
- Tests/Consults not entered - Personnel "taking off" the order enters the scheduled diagnostic test/consult in the log book
- Inconsistent and incomplete review of entries - Single staff made responsible for all follow-up including receiving results, identifying why results not received, and completing the action plan
- Incomplete understanding of value and importance of the tracking procedure - procedure and specific patient problems that resulted from lack of completing the process reviewed with staff at monthly staff meetings
- Inconsistent monthly review by attending bimonthly review realizing necessity of continued monitoring of critical procedures
- Time requirements of process - designate time for daily review and improve patient compliance with keeping scheduled appointments
- Consults and test results often not sent to clinic - log book organized by provider to allow for easier requests for missing results
Future directions: Computerization of tracking system and unified medical record
Conclusions: Understanding the systematic nature of medical errors underscores the importance of analyzing and redesigning systems. Development of nonpunitive environments are needed for safe and efficient patient practices, increased patient satisfaction, and quality of work life. Most medical education programs do not focus on risk quality management issues. Our system attempts to help prepare physicians by teaching them systematic processes for comprehensive review, that will enable them to practice more effectively in today's litigious and regulatory climate.
Conclusions: Understanding the systematic nature of medical errors underscores the importance of analyzing and redesigning systems. Development of nonpunitive environments are needed for safe and efficient patient practices, increased patient satisfaction, and quality of work life. Most medical education programs do not focus on risk quality management issues. Our system attempts to help prepare physicians by teaching them systematic processes for comprehensive review, that will enable them to practice more effectively in today's litigious and regulatory climate.
