Communication failures over diagnostic tests prompting more lawsuits

Failing to communicate diagnostic test results to patients and fellow physicians is leading to more doctors being sued.

Claim payouts due to communication breakdowns after tests rose by $70 million from 1991 to 2010 across all specialties, said a study in the November Journal of the American College of Radiology (link).

"Communication failure can happen at any level," said lead study author Brian Gale, MD, a radiologist at SUNY Downstate Medical Center in New York. "Any combination of things can go wrong, especially since doctors are so mobile these days. They're running all over. They're forced to see more patients. It's hard to access the information wherever they are, when they need it."

The study examined two sets of data: liability information from the National Practitioner Data Bank between 1991 and 2009 and claims from Controlled Risk Insurance Co./Risk Management Foundation (CRICO), Harvard Medical Institution's insurer. Between 2004 and 2008, communication failures accounted for 4% of lawsuits and 7% of total legal costs, according to the CRICO data.

Of the cases studied, the most common scenarios associated with communication problems were failure to notify the patient of the test result, telling the patient of an incorrect result and failing to notify the referring clinician.

Electronic systems as a solution

The results are in line with similar studies on physician-to-physician communication problems.

A study in the Jan. 10 Archives of Internal Medicine found wide disparities among the perceptions of primary care physicians and specialists of how often they send and receive patient information. The study showed that 69.3% of primary care physicians said they send specialists notification of patients' histories all or most of the time, while only 34.8% of specialists said they routinely receive such information.

Among specialists, 80.6% said they send consultation results to the referring physician all or most of the time, but only 62.2% of primary care physicians reported ever receiving that information (link).

Semiautomated critical test management systems could improve communication, the JACR study said. The systems are designed to reduce missed notifications by alerting referring clinicians of results and generating delivery receipts. Use of these systems has grown in the last five years, said Dr. Gale, who hopes more practices and hospitals consider implementing them.

Even without electronic systems, making sure information is received is essential to preventing test communication failures, he said.

"The key phrase is 'closed loop.' Whatever is delivered, you want to make sure it got delivered to the right person," Dr. Gale said. "It helps to have strong administrative policies in place where the whole staff agrees what the hand-off policy should be, so it's clear from the start."