Delayed Treatment- A Patient Safety Hazard

The World Alliance for Patient Safety made mention that poor test follow-up is one of the leading issues contributing to unsafe patient care (AAP). While many test results are routine, non-urgent, and can stand to take a back seat, others-are a matter of life and death. When these crucial lab results are not followed up on, treatment, potential life saving/ life altering treatment, may be missed or delayed.

This issue is very relevant within the pediatric population. According to American Academy of Pediatrics (2021), "Actionable pediatric laboratory values are potentially delayed up to 26% of the time in preliminary investigations compared to 7-65% in adults, leading to harm and malpractice claims." Having experience working with both children and adults, my observation is that many children are often able to compensate for longer than adults, but take a sharper nose dive.

For instance, you may have a pediatric patient who has a nasty cold, cough, etc. X1 week. It may seem like it's getting a tad worse, as time goes on, but the child's still playing, and running, and "seemingly" fine. Then around dinner within a matter of 30 minutes, the child goes from slight wheeze to respiratory distress but maintaining. And by the time you gather your items, car keys, and head out the door to the hospital 5 minutes away... the child is in significant distress. From slight wheeze, to significant distress in less than an hour.

Adults, I have found, are often more gracious in their plummet but are more likely to decline quicker over all.

A delay in test follow-up, may lead to a delay in treatment, or a delay in the correct treatment, especially when medications are needed. This delay may be more of an inconvenience when at the Primary Care Doctor's Office; however, this delay may mean the cost of a limb, or life in the acute care setting. For this reason poor-test follow up must be addressed and understood to be unacceptable and a breech in patient safety efforts.

Some helpful questions to ask when screening for delays in treatment:

1. Do providers read and acknowledge all lab results in the EHR inbox within designated timeframe as per policy?

2. Did the provider document "abnormal labs" or appropriate diagnosis?

3. Did the provider take an appropriate action and document it without delay?

A delay in treatment may also apply to a patient's inability to get an appointment or follow up appointment in a timely manner. The Joint Commission labels this as a form of diagnostic error that may result in patient harm or death.

According to The Joint Commission, leading factors for delays include:

• inadequate assessments

• poor planning

• communication failures

• and human factors.

The missed opportunity may result from cognitive and/or system factors, or may be attributable to more blatant factors, such as lapses in accountability or clear evidence of liability or negligence. Causes may include poor scheduling systems, understaffing, poor communications, misdiagnosis, and more.

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What Now?

If you have a case pertaining to potential delays in treatment, leading to poor outcomes, call us at Saundra Smyrski LLC today! 727.225.4358

**TIP**

From the cases I've seen, any occurrence of in-house cardiac arrest should be seen as a delay in treatment until proven otherwise.