Potential impact of a computerized system to report late-arriving laboratory results in the emergency department

Background: Results of some laboratory tests for Emergency Department (ED) patients return hours to days after the patient is discharged. Inadequate f ollow-up for these late-arriving results poses medical and legal risks. We have developed, but not Set implemented, a computerized system called the A utomated Late-Arriving Results Monitoring System (ALARMS). ALARMS scans the hospital's laboratory and ED registration databases to generate an electro nic daily log of all late-arriving abnormal laboratory results for ED patie nts. Objective: To determine the potential impact of ALARMS by assessing our ED' s current quality of documented follow-up of late-arriving laboratory resul ts. Methods: We applied ALARMS retrospectively, to find all abnormal late-a rriving laboratory results returned between 5/1/96 and 4/30/98 for ED patie nts for the following three tests: serum lead levels, Chlamydia cultures, o r urine pregnancy tests. Medical records were reviewed for documentation of follow-up, which was considered appropriate if a clinician noted the abnor mal result and documented a follow-up plan within 1 week after the result b ecame available. Medical records were also reviewed for any evidence of com plications attributable to delayed or inadequate follow-up. Results: Over the 2-year study period, no appropriate follow-up was documen ted in 6/18 (33%) cases of elevated lead levels, 3/4 (75%) cases of late-ar riving positive pregnancy tests, and 23/39 (59%) cases of positive Chlamydi a cultures. One case of a positive Chlamydia culture, for which there was n o documented follow-up, was associated with subsequent development of pelvi c inflammatory disease. Conclusion: Our current system of documented follow-up for late-arriving la boratory results has deficiencies, ALARMS, a computerized system of alerts for emergency physicians, has the potential to substantially improve docume nted follow-up of late-arriving laboratory results in the ED.