Failure to Follow Up on an Abnormal Test Result

Ordering a test is only the first step. A healthcare provider must also review the result, recognize when it is abnormal, communicate important findings, and arrange the follow-up care the patient needs. When a radiology report, pathology result, or critical laboratory value is overlooked or never acted upon, a treatable condition can become a catastrophic injury.

Hoffer & Sheremet represents Michigan patients and families in complex medical malpractice and wrongful death cases. If you believe an abnormal result was missed, delayed, or lost in the system, our attorneys can investigate what happened and help you understand your options.

Request a free, confidential case review or call 616.278.0888.

When an Abnormal Test Result Is Not Followed Up

A test-result follow-up failure can happen even when the test itself was performed correctly and accurately interpreted. The problem occurs after the result becomes available: no one reviews it, the finding is not communicated, a recommended repeat test is never ordered, or a specialist referral is not completed.

Safe care requires a closed loop. The ordering provider, interpreting physician, laboratory, hospital, and other members of the care team may each have responsibilities for making sure an important result reaches the right person and leads to timely action. Simply placing a result in an electronic chart or patient portal may not be enough when the finding is urgent, unexpected, or likely to cause serious harm if ignored.

Common Examples of Failure to Follow Up

Radiology Reports

Imaging studies often reveal findings that require prompt treatment, additional testing, or surveillance. A patient may be told that an X-ray, CT scan, MRI, ultrasound, or mammogram was “fine” even though the final radiology report identifies a serious abnormality.

Examples include:

• A lung nodule or suspicious mass is reported on a chest X-ray or CT scan, but no repeat imaging, biopsy, or oncology referral is arranged.
• A mammogram or breast ultrasound recommends additional imaging or biopsy, but the patient is never contacted.
• A CT scan identifies an intracranial hemorrhage, stroke, pulmonary embolism, aortic dissection, aortic aneurysm, or another urgent condition, but the result is not promptly communicated to the treating team.
• An emergency-room preliminary reading is later changed by the radiologist, but the patient is not called back for treatment.
• An incidental kidney, liver, pancreatic, thyroid, ovarian, or bone lesion is documented with a recommendation for follow-up, but the recommendation is never acted upon.
• A fracture, spinal abnormality, or sign of infection is missed during the transition from the emergency department to outpatient care.

When significant or unexpected imaging findings are not communicated and tracked, the opportunity for an early diagnosis may be lost.

Pathology and Biopsy Reports

Pathology results can provide the first definitive evidence of cancer, precancerous disease, infection, or another serious condition. A failure to review or communicate a pathology report can delay treatment for weeks, months, or longer.

Examples include:

• A biopsy shows cancer or cells suspicious for cancer, but the patient is told the result is benign or is never notified.
• A pathology report identifies high-grade dysplasia or precancerous changes, but recommended excision or surveillance is not arranged.
• A surgical specimen has positive margins, yet the patient is not referred for additional surgery, radiation, or oncology care.
• An amended or supplemental pathology report changes the diagnosis, but the new information never reaches the treating physician.
• A specimen is mislabeled, lost, assigned to the wrong patient, or left pending without anyone tracking the final result.
• An abnormal Pap test, HPV result, or endometrial biopsy is not followed by appropriate repeat testing, colposcopy, or specialist evaluation.

Critical Laboratory Results

Some laboratory values require immediate attention because they may signal a life-threatening emergency. Laboratories commonly flag critical values, but a warning is only useful if it is received, understood, and acted upon.

Examples include:

• Dangerously high or low potassium, sodium, glucose, calcium, or other electrolyte levels that can cause arrhythmias, seizures, coma, or death.
• A critically low hemoglobin level suggesting internal bleeding or severe anemia.
• An abnormal troponin result indicating possible heart injury or heart attack.
• Positive blood cultures, an elevated lactate level, or other evidence of a serious infection or sepsis.
• A dangerously low platelet count or abnormal clotting result that creates a risk of uncontrolled bleeding.
• Abnormal kidney or liver function tests that require medication changes, hospitalization, or urgent specialist care.
• A newborn bilirubin, blood-glucose, metabolic-screening, or infection result that requires immediate pediatric treatment.

Other Test and Referral Follow-Up Failures

Serious cases can also involve:

• Failure to act on abnormal prenatal testing, fetal monitoring, or genetic screening.
• Failure to follow up on positive cultures, infectious-disease tests, or antibiotic-sensitivity results after discharge.
• Failure to connect abnormal inflammatory markers, blood cultures, or spinal imaging to an evolving spinal epidural abscess, cauda equina syndrome, or spinal cord compression.
• Failure to arrange a colonoscopy after an abnormal stool test or to schedule repeat surveillance after polyps are removed.
• Failure to investigate an abnormal PSA, thyroid study, or other screening result.
• Failure to complete a referral to oncology, cardiology, neurology, gastroenterology, or another specialist.
• Failure to track results that remain pending when a patient leaves the emergency department or hospital.
• Failure to confirm that the patient received and understood instructions for repeat testing.

How Follow-Up Breakdowns Happen

Abnormal results are frequently lost during handoffs and transitions of care. A physician may assume another provider will manage the finding. An electronic alert may be routed to the wrong inbox, buried among routine notifications, or sent to a provider who is away. A hospital may discharge a patient before a culture or pathology report is final without assigning responsibility for reviewing the pending result.

Other breakdowns include inadequate office policies, failure to document patient contact, incomplete referral systems, incorrect contact information, staffing shortages, and overreliance on automated patient portals. Healthcare systems should have reliable processes for identifying abnormal results, notifying patients, documenting communication, ordering the next step, and confirming that the recommended care was completed.

Catastrophic Injuries Caused by Delayed Follow-Up

The harm depends on the condition and the length of the delay. In cancer cases, a suspicious radiology or pathology result may represent the patient’s best opportunity for diagnosis at an earlier stage. If the finding is ignored, the tumor may grow, invade nearby structures, or spread to lymph nodes and distant organs. A delay can lead to metastatic disease, more extensive surgery, chemotherapy or radiation that might otherwise have been avoided, fewer treatment options, reduced life expectancy, or death.

Other consequences can include:

• Sepsis, septic shock, organ failure, amputation, or death from an untreated infection.
• Heart attack, dangerous arrhythmia, cardiac arrest, or permanent heart damage.
• Stroke, brain injury, paralysis, cognitive impairment, or loss of independence.
• Kidney or liver failure requiring dialysis, transplant evaluation, or lifelong treatment.
• Seizures, coma, or neurological injury caused by severe electrolyte or glucose abnormalities.
• Hemorrhage, hypovolemic shock, or death from untreated bleeding.
• Preventable pregnancy complications, fetal injury, or newborn brain damage.
• The need for more invasive treatment, prolonged hospitalization, rehabilitation, and lifelong care.

Not every abnormal result causes harm, and not every delayed diagnosis is malpractice. A case depends on what a reasonably careful provider should have done, how quickly follow-up was required, and whether timely action would probably have changed the outcome.

When Failure to Follow Up May Be Medical Malpractice

A Michigan medical malpractice claim generally requires proof that a healthcare provider failed to meet the accepted standard of care and that the failure caused additional injury. In a test-result case, medical experts may evaluate whether the provider should have reviewed the result sooner, communicated it differently, ordered additional testing, made a referral, or sent the patient for emergency treatment.

Causation is often the central issue. The investigation must compare what actually happened with the likely outcome if the abnormal result had been handled appropriately. For example, experts may examine whether earlier cancer treatment would have prevented metastasis, whether prompt antibiotics would have stopped an infection from progressing to sepsis, or whether urgent treatment of a critical laboratory value would have prevented cardiac or neurological injury.

Evidence That Can Reveal What Happened

These cases often turn on records beyond the test report itself. Important evidence may include:

• The original radiology, pathology, or laboratory report and any later addendum.
• Electronic health-record inboxes, alerts, acknowledgment logs, and audit trails.
• Telephone notes, portal messages, certified letters, and other attempts to contact the patient.
• Referral orders, scheduling records, and documentation showing whether follow-up was completed.
• Hospital discharge instructions and lists of tests still pending at discharge.
• Office policies for reviewing results and covering another provider’s inbox.
• Prior imaging or laboratory trends that made the abnormality more concerning.
• Expert analysis of when treatment should have begun and how the delay changed the patient’s prognosis.

Hoffer & Sheremet carefully reconstructs the timeline, obtains the relevant records, and works with qualified medical experts to determine where the communication or follow-up process failed.

What to Do If You Suspect a Result Was Missed

Ask for complete copies of the test report, your medical records, and any patient-portal messages. Write down when the test was performed, what you were told, when you learned the true result, and what treatment followed. Keep letters, voicemail messages, appointment notices, and billing records that may help establish the timeline.

Michigan medical malpractice claims are subject to strict notice and filing deadlines, and calculating those deadlines can be complicated. Learn more about statutes of limitation and repose, and speak with an attorney promptly if a delayed follow-up caused serious harm.

Why Choose Hoffer & Sheremet

Our firm focuses on medical malpractice, catastrophic injury, and wrongful death litigation. We understand how to analyze complex medical records, electronic communication trails, hospital systems, and the expert issues that determine whether a delayed result changed a patient’s outcome.

• Focused experience with complex medical malpractice cases.
• Detailed investigation and review by qualified medical experts.
• Compassionate, direct communication with patients and families.
• Trial-ready representation throughout Michigan.
• No attorney fee unless we obtain a recovery.

Frequently Asked Questions

Is an abnormal test result automatically evidence of malpractice?

No. The issue is whether the result required follow-up, whether the responsible provider acted reasonably, and whether a delay caused additional harm. Expert review is usually necessary.

Who may be responsible for a missed result?

Responsibility may involve the ordering physician, radiologist, pathologist, laboratory, primary-care provider, specialist, hospital, clinic, or healthcare system. More than one provider may share responsibility when communication and tracking systems fail.

What if the result appeared in my patient portal?

A portal release does not necessarily resolve whether reasonable follow-up occurred. The urgency and complexity of the finding, the communication sent to the patient, and the steps taken to ensure needed care are all important.

Can there be a case if the diagnosis was eventually made?

Yes. The question is whether the delay caused a worse outcome, such as disease progression, more invasive treatment, permanent injury, or reduced chance of survival.

Sources and Further Reading

For additional information about the patient-safety and medical issues discussed on this page:

• AHRQ Patient Safety Network: Failure to Follow Up Test Results for Ambulatory Patients
• American College of Radiology: Practice Parameter for Communication of Diagnostic Imaging Findings
• National Cancer Institute: Metastatic Cancer—When Cancer Spreads

Start Your Free, Confidential Case Review

If you or a loved one suffered a catastrophic injury because an abnormal test result was not reviewed, communicated, or acted upon, contact Hoffer & Sheremet. We represent families throughout Michigan.

Call 616.278.0888 or use the secure form below. No appointment is necessary for an initial phone consultation.