Left in the Dark: Consequences of Failing to Follow Up or Monitor Care Leading to Medical Malpractice

Failure to follow up on lab results is a common reason for adverse care outcomes for patients.

Introduction

In today’s complex healthcare environment, ensuring that a patient receives appropriate follow-up and monitoring is as essential as making the right diagnosis or prescribing the right treatment. Yet, failure to follow up on abnormal test results, monitor a patient's progress post-discharge, or act on secondary findings remains one of the most common and devastating types of medical malpractice. It leaves patients vulnerable to worsening conditions, delayed treatment, and preventable harm. And it costs our healthcare system billions each year as patients return for care in hospitals as readmissions and reencounters.

This blog explores the systemic challenges that contribute to these failures, highlights real-world cases, and provides both patients and families with practical advice on how to advocate for safer care. It also introduces how EvaluCare's team of experienced healthcare professionals can help patients identify whether lapses in care have resulted in preventable harm.

Understanding the Scope of Failure to Follow Up

Failure to follow up includes:

• Ignoring or mismanaging abnormal test results.

• Missing incidental findings noted on imaging or lab results.

• Inadequate monitoring after procedures or hospital discharge.

• Lack of coordination across different providers or settings.

• Failure to enter external results into an a health record of the organization responsible for managing care.

  
  

According to the ECRI Institute, "Failure to follow up on test results" is among the top 10 patient safety concerns annually. A 2013 study in BMJ Quality & Safety found that 7% of abnormal outpatient lab results were not followed up appropriately, leading to delays in care and diagnostic errors. The main contributing factor to failure to follow up is a breakdown in communication of critical information from one provider to another, and many times to patients and families themselves.

Challenges in Monitoring and Coordinating Care

1. Poor Care Coordination:

   • Transitioning between care settings (e.g., hospital to home or primary care) often results in information not transferred or lost.

   • There is no universal system for alerting providers when a follow-up is needed.

   • In recent years, due to the frequency of these events health records can queue follow ups even when the primary entity fails to do so.

     
     

2. Resource Limitations:

   • Community hospitals or outpatient clinics may lack access to specialists or diagnostic services.

   • Staffing shortages exacerbate delays in communication and care delivery.

     
     

3. Reliance on Mid-Level Providers:

   • Nurse practitioners and physician assistants provide valuable support but may miss subtleties in complex cases if not properly supervised.

     
     

4. Fragmented Systems:

   • Hospitals, primary care providers, and specialists often use different electronic health records (EHRs), making it difficult to share timely information.

     
     

5. Patient Demographics and Isolation:

   • More older adults live alone, and fewer have family available to serve as care advocates.

   • Aging patients are more likely to have chronic diseases that require careful and ongoing management.

     
     

6. High Utilization and Burnout:

   • Increased demand for healthcare services has led to shorter appointments, provider fatigue, and errors of omission.

     
     

From Continuity to Fragmentation: The Shift in Provider Roles

In the past, a patient’s primary care physician (PCP) often admitted them to the hospital and remained involved throughout the hospital stay. Today, hospitalists, physicians who specialize in inpatient care, have largely taken over these roles. While this has benefits, it can also result in poor handoffs and disconnected care plans, especially if the PCP is not looped in post-discharge.

A 2019 JAMA study found that nearly 25% of hospital discharges involved incomplete or missing information for follow-up care. This disjointed system puts patients at risk for complications and hospital readmissions.

Real-World Legal Cases Highlighting Failure to Monitor

1. Delayed Cancer Diagnosis (Florida, 2017): A patient’s elevated prostate-specific antigen (PSA) result was flagged in the system but never followed up by his provider. By the time the cancer was diagnosed, it was terminal. The family was awarded $2 million.

   
   

2. Missed Aneurysm Monitoring (California, 2016): A radiologist noted a small cerebral aneurysm on a CT scan but failed to communicate the finding. Years later, the patient suffered a massive stroke. The case settled for $5.5 million.

   
   

3. Failure to Act on Post-Surgical Labs (Texas, 2020): Abnormal electrolyte levels were never addressed after a patient's gallbladder surgery, leading to cardiac arrest. The hospital paid $3.2 million in damages.

   
   

These cases underscore how a simple missed alert or unreturned call can result in life-altering harm.

The Aging Population and Chronic Disease Management

According to the CDC, 6 in 10 adults in the U.S. have a chronic disease, and 4 in 10 have two or more. The most common include:

• Diabetes

• Congestive Heart Failure (CHF)

• Chronic Obstructive Pulmonary Disease (COPD)

• Alzheimer’s and Dementia

  
  

As of 2023, over 55 million Americans were aged 65 or older, with projections estimating this will rise to 80 million by 2040. Many of these individuals live alone, making it difficult for healthcare providers to follow up, and for patients to manage care transitions or complex regimens without support.

The Risk of Falling Through the Cracks

The increase in the use of mid-level providers and automated EHR systems can create a false sense of security. Alerts and reminders can be overlooked in busy practices. Provider inboxes are overflowing with data on patients. A 2022 report from CRICO found that 58% of malpractice cases involving diagnosis errors were due to failure to follow up on test results.

Hospitals often rely on teams rather than individuals to manage care, making it easy to assume someone else is responsible for follow-up. Unfortunately, this diffusion of responsibility often leads to no one taking ownership.

What Patients and Families Can Do to Prevent Failures

1. Be Proactive:

   • Always ask about test results, and don’t assume "no news is good news."

     
     

2. Use Patient Portals:

   • Many hospitals and clinics offer online access to test results, visit summaries, and provider messaging.

     
     

3. Designate a Family Advocate:

   • Especially for elderly or vulnerable patients, having a family member who can attend appointments, keep records, and follow up can be life-saving.

     
     

4. Keep a Personal Health Journal:

   • Document symptoms, questions for providers, medications, and any changes in condition.

     
     

5. Request Discharge Summaries:

   • Ensure that both the patient and the primary care provider receive a detailed summary after hospital stays.

     
     

6. Schedule Follow-Ups Before Leaving the Hospital or Clinic:

   • Don't rely on staff to call later. Get appointments on the calendar immediately.

     
     

How EvaluCare Can Help When Follow-Up Fails

When follow-up is missed and harm occurs, patients often feel helpless. That’s where EvaluCare can partner with patients and families in getting answers by reviewing if care follow acceptable standards including follow up.

EvaluCare is a team of compassionate, experienced healthcare professionals, including former quality officers, clinicians, and care managers, who know the system from the inside. We provide:

• Expert Review of Medical Records: Identifying lapses in care and determining if negligence occurred.

• Support for Direct Settlements: Helping patients pursue resolution with providers without necessarily involving a lawsuit.

• Guidance and Advocacy: Explaining complex medical issues in plain language and helping patients understand their rights and options.

  
  

We understand the devastation that comes from preventable harm, especially when a patient believed they were on the path to healing. Our mission is to uncover the truth and support families through their most difficult moments.

Conclusion: Vigilance, Advocacy, and Hope

The healthcare system is overburdened, fragmented, and often under-resourced. It is said we are headed for a silver tsunami of older Americans that will push our health system to the brink. But patients don’t have to navigate it alone. Failures to follow up and monitor can lead to serious harm, but with vigilance, advocacy, and expert support, these risks can be mitigated.

If you or someone you love has been harmed because a provider failed to follow up or monitor properly, EvaluCare can help you find answers. We bring not just knowledge, but compassion—because we believe that everyone deserves to know the truth and receive the care they were promised.

Learn more at www.EvaluCare.net or email info@EvaluCare.net

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References:

• BMJ Qual Saf. 2013;22(4):298-304.

• CRICO. 2022 Malpractice Risks in the Diagnostic Process.

• CDC. Chronic Disease Overview.

• ECRI Institute. 2022 Top 10 Patient Safety Concerns.

• JAMA. 2019;322(17):1642-1649.

• U.S. Census Bureau, 2023 Population Projections.