A test result that nobody acts on is one of the most preventable sources of diagnosis-related claims. The test was ordered and the result came back, but it went to a clinician who had left the practice, sat in an inbox during a vacation, or was never explained to the patient. Months later the patient returns with a cancer that the earlier result pointed to. These cases are difficult to defend because the information was in the practice's own system. This article explains how results get lost, the federal rules that now shape how results reach patients, and a practical closed-loop process.
How results fall through the cracks
Missed results are rarely a single person's failure. They usually come from gaps between steps that nobody owns:
Ordered, never done
The patient never had the test, and no one noticed that the result never arrived.
Wrong recipient
The result went to an ordering clinician who left, a covering provider, or a resident who rotated off.
Reviewed, not acted on
The result was acknowledged in the EHR, but the follow-up order, referral or call never happened.
Not communicated
The patient was never told, or was told "no news is good news" and assumed the result was normal.
Pending at discharge
A result finalized after the patient left the hospital or emergency department, with no clear owner.
Incidental findings
A radiology report recommends follow-up imaging for an unrelated nodule, and the recommendation is lost.
These are the same failure points that drive many diagnostic error claims, and they often overlap with weak handoffs between clinicians.
Patients now see results quickly
Federal information blocking rules under the 21st Century Cures Act have changed the timing of result communication. Many patients now see results in the portal at the same time as, or before, their clinician.
- Blanket delays are a problem. The federal health IT office (ASTP/ONC) says blanket delays that affect a broad range of routine results do not qualify for the information blocking rule's Preventing Harm Exception.
- Individual judgment is allowed. An ordering clinician can make an individualized, good-faith determination that withholding a specific result would substantially reduce a risk to the life or physical safety of the patient or another person, provided the exception's other conditions are met.
- There are consequences for providers. Under a 2024 HHS final rule, providers that the HHS Office of Inspector General finds have committed information blocking face Medicare disincentives. Clinicians in MIPS can receive a zero score in the Promoting Interoperability category, hospitals can lose part of their annual market basket update, and ACOs or their participants can be barred from the Medicare Shared Savings Program for at least a year.
Plan for the patient seeing it first. Talk with patients before ordering tests about when and how results will appear, what an abnormal flag does and does not mean, and how they will hear from you. Patients who are told what to expect call less and worry less, and the conversation itself is evidence of good communication. See patient communication for more.
Critical results need a defined process
Critical results, such as a dangerously low potassium or an unexpected pneumothorax, need to reach a responsible licensed caregiver quickly. The Joint Commission's 2026 laboratory National Patient Safety Goal NPSG.02.03.01 requires written procedures that define critical results, who reports them and to whom, and the acceptable time between availability and reporting, along with evaluation of how timely reporting actually is. Hospitals moved to the Joint Commission's new National Performance Goals in 2026, so check the current standard for your program, but the same elements make sense for any practice:
- A written list of critical values and critical imaging findings, agreed with the lab and radiology.
- A named responsible clinician for every result, with backup when that person is unavailable.
- A time standard for reporting, and a documented read-back of the result.
- An escalation path if the clinician cannot be reached.
- Periodic audits of how long reporting actually takes.
A closed-loop process for every result
Every test should move through the same five stages, with a named owner at each one.
- Track the order. Use the EHR's order tracking so that tests ordered but not resulted after a set period appear on a work list. Staff then contact the patient or the lab.
- Route to a person, not a role that may be empty. Results should go to the ordering clinician, with automatic rerouting when a clinician leaves, is on vacation or is off service. Audit for orphaned inboxes when anyone departs.
- Review and decide. The clinician reviews the result and records a decision: normal, no action; abnormal, action needed; or abnormal, already addressed.
- Communicate to the patient. Tell patients about every result, including normal ones, using a consistent method. For abnormal results, confirm the patient received the message, and document it.
- Complete the follow-up. Place the order or referral, schedule it with the patient where possible, and track it to completion. If the patient does not follow through, make and document reasonable outreach attempts.
| Weak point | Control |
|---|---|
| Results pending at discharge | List pending results in the discharge summary and assign a responsible clinician by name |
| Incidental imaging findings | Structured radiology recommendations that create a tracked follow-up task |
| Referral never completed | Referral tracking with a "loop closed" step when the consult note arrives |
| Patient unreachable | Several attempts by different methods, then a letter; document each attempt |
| Departing clinicians | Offboarding checklist that reassigns open results and tasks before the account is closed |
Document as if someone will read it later
In a delayed-diagnosis claim, the questions are simple: when did the result arrive, who saw it, what did they do, and was the patient told? The EHR audit trail will show when the result was opened. Your notes should show the decision and the communication. A short note such as "Reviewed CT, 6 mm nodule, follow-up CT ordered for six months, discussed with patient by phone, patient agrees" answers all four questions. See medical documentation best practices and our article on EHR liability risks for how metadata is used in litigation.
How insurance responds, and where gaps appear
Claims alleging a failure to follow up on test results are generally professional liability claims, handled under a medical malpractice or healthcare professional liability policy. A few points are worth checking:
- Claims-made timing. Missed-result claims often surface years later. If you change carriers or retire, prior acts coverage or an extended reporting period (tail) determines whether an old missed result is covered.
- Entity and individual coverage. Results systems are run by the practice. Make sure the entity is insured, not only the clinicians, because claims often target the system.
- Portal and messaging technology. A breach or misdirected release of results through a patient portal is generally a cyber exposure. See cyber liability for healthcare practices.
- Information blocking. Medicare disincentives are regulatory consequences, not insured losses, and are generally not something insurance pays.
Coverage depends on the specific policy form, endorsements and exclusions, which vary by carrier.
When to call a broker
Call your broker if you learn of a result that was missed, before you change EHRs or carriers, when a clinician retires or leaves, and at renewal, when a documented results-management process can support your application. Contact us to review your coverage.
Sources
- HealthIT.gov — Would the Preventing Harm Exception cover a blanket delay in releasing results?
- HealthIT.gov — Information blocking disincentives final rule fact sheet
- The Joint Commission — 2026 National Patient Safety Goals, Laboratory Program
- Fierce Healthcare — Joint Commission accreditation overhaul for 2026