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

Pediatr Emerg Care. 2000 Oct;16(5):313-5. doi: 10.1097/00006565-200010000-00002.


Background: Results of some laboratory tests for Emergency Department (ED) patients return hours to days after the patient is discharged. Inadequate follow-up for these late-arriving results poses medical and legal risks. We have developed, but not yet implemented, a computerized system called the Automated Late-Arriving Results Monitoring System (ALARMS). ALARMS scans the hospital's laboratory and ED registration databases to generate an electronic daily log of all late-arriving abnormal laboratory results for ED patients.

Objective: To determine the potential impact of ALARMS by assessing our ED's current quality of documented follow-up of late-arriving laboratory results.

Methods: We applied ALARMS retrospectively, to find all abnormal late-arriving laboratory results returned between 5/1/96 and 4/30/98 for ED patients for the following three tests: serum lead levels, Chlamydia cultures, or urine pregnancy tests. Medical records were reviewed for documentation of follow-up, which was considered appropriate if a clinician noted the abnormal result and documented a follow-up plan within 1 week after the result became available. Medical records were also reviewed for any evidence of complications attributable to delayed or inadequate follow-up.

Results: Over the 2-year study period, no appropriate follow-up was documented in 6/18 (33%) cases of elevated lead levels, 3/4 (75%) cases of late-arriving positive pregnancy tests, and 23/39 (59%) cases of positive Chlamydia cultures. One case of a positive Chlamydia culture, for which there was no documented follow-up, was associated with subsequent development of pelvic inflammatory disease.

Conclusion: Our current system of documented follow-up for late-arriving laboratory results has deficiencies. ALARMS, a computerized system of alerts for emergency physicians, has the potential to substantially improve documented follow-up of late-arriving laboratory results in the ED.

Publication types

  • Evaluation Study

MeSH terms

  • Aftercare / organization & administration*
  • Chlamydia Infections / diagnosis
  • Clinical Laboratory Information Systems / organization & administration*
  • Clinical Laboratory Techniques*
  • Emergency Service, Hospital*
  • Hospitals, Pediatric
  • Humans
  • Laboratories, Hospital / organization & administration*
  • Lead Poisoning / diagnosis
  • Pregnancy Tests
  • Program Evaluation
  • Retrospective Studies
  • Time Factors