LITTLE FALLS, N.J., July 7-- Clinicians may miss a substantial number of new abdominal aortic dilations on CT scans, researchers have found.
Clinical teams didn't record about 60% of dilations within three months of the scan in an electronic medical record system, Peter Cram, MD, of the Iowa City VA, and colleagues reported in the July 7 issue of Annals of Internal Medicine.
"New aortic dilations were often recognized by clinicians only after substantial delay and 18% of dilations were never documented during an average follow-up of more than three years," the researchers said. "However, it is somewhat reassuring that we found no evidence of patient harm as a result of the delays that were identified."
Action Points
- Explain to interested patients that clinicians didn't record a significant number of abdominal aortic aneurysms in an electronic medical record within three months of CT scan, highlighting the possibility of medical error.
- Note, however, that the findings could be a result of clinicians failing to document some findings in the electronic medical record.
They noted that concern has been growing about the possibility of missed test results, but there was still scant research in this area of medical errors.
So to examine the frequency of errors in identifying one condition -- abdominal aortic aneurysm -- the researchers conducted a retrospective cohort study of 4,112 patients who'd had CT scans of the abdomen and pelvis in two hospitals in the Veterans Affairs Healthcare System in 2003.
They compared the data from the scans with data in electronic medical records (EMR) kept by the VA systems.
Among the 440 aortic dilations identified in CT scans, 91 were new findings, the researchers said.
They found that in reviewing the CT reports, radiologists infrequently notified the clinical teams of the aortic abnormalities. Also, notification was no more common for larger abnormalities than for smaller ones.
They did, however, find that abnormalities recognized within three months of the scan were significantly larger than those not recognized within three months (P<0.001).
Moreover, 9% of aneurysms unidentified were 5.5 cm or larger, and clinical teams didn't recognize 58% of dilations within three months of the scan.
The median time to recognition of aneurysm in the EMR was 237 days.
After 3.2 years, there was no evidence in the EMR of 29% of patients that abnormalities were ever recognized.
The study may have been limited because clinicians may have recognized some aneurysms but did not document them in the EMR.
Nonetheless, Dr. Cram and colleagues concluded that clinicians often "neglect to note a substantial proportion of new aortic dilations in the EMR," and that their findings "highlight the need for innovative solutions to ensure that the abnormal findings are consistently recognized and documented by clinical care teams."
| The study was funded by grants from the NIH, the Robert Wood Johnson Foundation, and the Department of Veterans Affairs.
The researchers reported no conflicts of interest. |
Primary Source
Annals of Internal Medicine
Gordon JRS, et al "Failure to recognize newly identified aortic dilations in a healthcare system with an advanced electronic medical record" Ann Intern Med 2009; 151: 21-27.