This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Moore, C. Articles by Halm, E. Search for Related Content PubMed PubMed Citation Articles by Moore, C. Articles by Halm, E. Social Bookmarking                         What's this?

Factors Associated with Time to Follow-up of Severe Hyperkalemia in the Ambulatory Setting

Division of General Internal Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, New York, carlton.moore{at}mssm.edu

Jenny Lin, MD

Division of General Internal Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, New York

Thomas McGinn, MD, MPH

Division of General Internal Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, New York

Ethan Halm, MD, MPH

Division of General Internal Medicine, Department of Medicine and at the Department of Health Policy, Mount Sinai School of Medicine, New York, New York

Background. Few studies have investigated the time it takes physicians to follow up abnormal outpatient laboratory results. Methods. Medical record review of all adult patients seen at a primary care practice between January 2002 and December 2005 with serum potassium results 6.0 mEq/L. We used a proportional hazards model to assess factors associated with time to follow-up for episodes of hyperkalemia. Results. 259 of 48 333 serum potassium results met inclusion criteria. The median follow-up time was 3 days; after 30 days, 10% of cases had no follow-up. Residing in the same zip code as the clinic (HR = 1.39; P = .029), degree of hyperkalemia (HR = 2.97; P < .001), and renal insufficiency (HR = 1.41; P = .015) were associated with decreased time to repeat testing. Conversely, African Americans (HR = .51; P = .007) had increased time to repeat testing. Conclusions. Follow-up of abnormal laboratory results in outpatients is suboptimal and research is needed to better understand factors that delay follow-up. (Am J Med Qual 2007;22:428-437)

Key Words: follow-up • abnormal tests • medical errors • hyperkalemia • ambulatory

References

• Plews-Ogan ML, Nadkarni MM, Forren S., et al. Patient safety in the ambulatory setting. J Gen Intern Med. 2004; 19:719-725.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Ahrq. Patient fact sheet: 20 tips to help prevent medical error. Available at: http://www.ahrq.gov/consumer/20tips.htm. Accessed July 2006.
• Poon EG, Gandhi TK, Sequist TD, Murff HJ, Karson AS, Bates DW " I wish I had seen this test result earlier!": Dissatisfaction with test result management systems in primary care. Arch Intern Med. 2004;164:2223-2228.[Abstract/Free Full Text]
• Boohaker EA, Ward RE, Uman JE, McCarthy BD Patient notification and follow-up of abnormal test results. A physician survey. Arch Intern Med. 1996;156:327-331.[Abstract/Free Full Text]
• Lin JJ, Dunn A., Moore C. Follow-up of outpatient test results: a survey of house-staff practices and perceptions. Am J Med Qual. 2006;21:178-184.[Abstract/Free Full Text]
• Schepkens H., Vanholder R., Billiouw JM, Lameire N. Life-threatening hyperkalemia during combined therapy with angiotensin-converting enzyme inhibitors and spironolactone: an analysis of 25 cases. Am J Med. 2001;110:438-441.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Reardon LC, Macpherson DS Hyperkalemia in outpatients using angiotensin-converting enzyme inhibitors. How much should we worry? Arch Intern Med. 1998;158:26-32.[Abstract/Free Full Text]
• Perazella MA, Mahnensmith RL Hyperkalemia in the elderly: drugs exacerbate impaired potassium homeostasis. J Gen Intern Med. 1997;12:646-656.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Juurlink DN, Mamdani MM, Lee DS, et al. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med. 2004;351:543-551.[Abstract/Free Full Text]
• Blake J., Devereux RB Differential effects of direct antagonism of AII compared to ACE inhibitors on serum potassium levels and azotemia in patients with severe congestive heart failure. Congest Heart Fail. 2000;6:193-196.[Medline] [Order article via Infotrieve]
• Charytan D., Goldfarb DS Indications for hospitalization of patients with hyperkalemia. Arch Intern Med. 2000;160: 1605-1611.[Abstract/Free Full Text]
• Rimmer JM, Horn JF, Gennari FJ Hyperkalemia as a complication of drug therapy. Arch Intern Med. 1987;147:867-869.[Abstract/Free Full Text]
• Acker CG, Johnson JP, Palevsky PM, Greenberg A. Hyperkalemia in hospitalized patients: causes, adequacy of treatment, and results of an attempt to improve physician compliance with published therapy guidelines. Arch Intern Med. 1998;158:917-924.[Abstract/Free Full Text]
• Rose BD Clinical manifestations and treatment of hyperkalemia. UpToDate [online]. Version 15.1. 2007. Available at: http://www.uptodateonline.com/utd/index.do. Accessed May 2006.
• Gurwitz JH, Field TS, Harrold LR, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289:1107-1116.[Abstract/Free Full Text]
• Gandhi TK, Weingart SN, Borus J., et al. Adverse drug events in ambulatory care. N Engl J Med. 2003;348:1556-1564.[Abstract/Free Full Text]
• Poon EG, Haas JS, Louise Puopolo A, et al. Communication factors in the follow-up of abnormal mammograms. J Gen Intern Med. 2004;19:316-323.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Kravitz RL, Rolph JE, Petersen L. Omission-related malpractice claims and the limits of defensive medicine. Med Care Res Rev. 1997;54:456-471.[Abstract/Free Full Text]
• Chang SW, Kerlikowske K., Napoles-Springer A., Posner SF, Sickles EA, Perez-Stable EJ Racial differences in timeliness of follow-up after abnormal screening mammography. Cancer. 1996;78:1395-1402.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Jones BA, Dailey A., Calvocoressi L., et al. Inadequate follow-up of abnormal screening mammograms: findings from the Race Differences in Screening Mammography Process study (United States). Cancer Causes Control. 2005;16:809-821.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Reason J. Human Error. Cambridge, UK: Cambridge University Press; 1990:199-212.
• Poon EG, Wang SJ, Gandhi TK, Bates DW, Kuperman GJ Design and implementation of a comprehensive outpatient Results Manager. J Biomed Inform. 2003;36:80-91.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]

American Journal of Medical Quality, Vol. 22, No. 6, 428-437 (2007)
DOI: 10.1177/1062860607305245


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Moore, C. Articles by Halm, E. Search for Related Content PubMed PubMed Citation Articles by Moore, C. Articles by Halm, E. Social Bookmarking                         What's this?