Improving Investigation Result Sign-Off Through Multifaceted Interventions in Elderly Medicine: A Quality Improvement Project

Introduction 

Signing off investigation results is essential to ensure timely and safe patient care. Missed results contribute to adverse patient outcomes and duplication of work. GGC Healthboard moved to electronic sign off of results in 2021; compliance has been poor. 

Project Aim: 80% of patients in the older patient's wards will have all results signed off within 48 hours of publication. 

Method 

Using PDSA methodology we tested several change ideas over 10 months: 

1. Creation of standard operating procedure with clear roles for residents and consultants.  Shared via email, SharePoint and posters.  
2. Education on the importance of signing off results through surveys, discussion of related patient safety events at M+M meetings, discussion at Consultant meetings, embedding in ward rounds and teaching at induction. 
3. Introduction of a visual reminder mascot ‘Bookie’ on posters and stickers on desks and laptops.    

Data was collected at baseline and weekly intervals.  

Outcome Measure: % of patients with ALL results signed off within 48 hours of publication 

Process Measure: Percentage of patients with unsigned (laboratory, radiology and microbiology) results within 48 hours of publication. 

Results 

Over the 10 months we sampled 690 patients in total. Baseline median demonstrated 72% of patients had all results signed off at 48 hours. Following the PDSA cycles, we demonstrated a shift towards improvement (new median=83.5%). 

The breakdown of results over the 10-month project period is as follows: 

• Laboratory: Sustained shift in median from 16% to 10.5% 
• Microbiology:  Sustained shift in median from 15% to 5.5% 
• Radiology: Median maintained at 3%  

Conclusion 

Using QI methodology, with multifaceted change ideas, we achieved an improvement in performance in our outcome and process measures. We achieved our aim with an average of 83.5% of patients having all results signed off within 48 hours. We will continue monitoring to ensure sustainability.