A Potentially Perilous Practice: Discharging Patients Prior to Obtaining All Lab Results and Orders

It is being reported that discharging a patient prior to obtaining all lab results or orders has become more routine in the national healthcare setting.[1]  The reports of over-crowded hospitals and EDs, limited staffing, the desire to reduce healthcare costs, automatic orders, and simple patient or family discharge requests make it ubiquitous.  However, providers should appreciate the risks associated with the practice.  Missed diagnoses, medical errors, and potentially unresolved medical issues can all create liability for providers.

From a risk mitigation point of view, it is critical to provide clear communication and instructions to a patient when one is discharged.  When pending tests or lab results are outstanding, the bar to clear for an effective communication becomes even higher. In such instances, we recommend the following:

  1. Communicating to the patient (and one’s family, if appropriate), both in written discharge instructions and verbally, that not all results have been obtained, and as such, prescription modifications or other clinical adjustments may be required. 

  1. Advising the patient to follow-up with their provider if they have heard nothing within a certain timeframe (e.g., one week) is prudent. 

  1. Maintaining a clear line of communication with the balance of the care team, including residents and fellows, so that all interested parties understand their roles and responsibilities with regard to the discharge and any pending results. The same applies when a patient is transitioning from the ED to an inpatient unit; all interested parties need to understand the expectations and roles of individual team members.

  1. If a patient is discharged with outstanding tests or labs merely as a result of automatic orders being placed at the outset of one’s admission, consider specifically documenting that such orders are automatic and may or may not be clinically relevant.  There is still liability risk if a missed test or lab result ultimately leads to an adverse outcome, but it will provide contemporaneous context for why an order was placed and its significance.

The practice of discharging patients with pending tests or lab results cannot be ignored in today’s healthcare environment.  Being cognizant of when such a scenario will arise, and being diligent in communicating with all interested parties when it does, will better protect you from liability.  Please call the Trust at (434) 296-2100 if you have any risk management or documentation-related questions.