Case Presentation
A middle-aged man became critically ill and developed significant complications after surgery, resulting in an extended stay in the ICU. He required blood pressure support with intravenous medications, mechanical ventilation, and dialysis for renal failure. Throughout his stay, his wife was continuously at his bedside, very attentive to management decisions about his care. Because the patient had signed up for portal access as an outpatient, he and his wife had immediate access to his online laboratory results and radiology reports.
The patient's wife used her own laptop and the hospital's guest wireless network to access the portal and view her husband's results. Often, she saw his results before any of his nurses or physicians. New results often prompted prolonged discussions with various members of the care team. For example, she monitored her husband's arterial blood gas results very closely, and she used internet resources to help her interpret the results. (Arterial blood gasses are drawn frequently in patients with respiratory and renal failure.) She deduced at one point that her husband had a respiratory acidosis and suggested that her husband's ventilator settings be changed immediately to correct it. She perceived that the care team did not act quickly enough in response to the results and that her husband's care was consequently compromised.
She also followed his serum creatinine, a marker of kidney function and part of a blood chemistry panel, very closely. After he started dialysis, she interpreted the decrease in his serum creatinine as signifying improvement in his kidney function, even though it fell because of effective dialysis. She was distraught to learn that his kidney function had not actually improved.
We interviewed two ICU nurses and the physician who cared for the patient and interacted with his wife while he was in the ICU.
One nurse felt that immediate access to online test results hurt the patient's overall care. He felt that he was pulled away from his clinical duties to interpret medical data for the patient's wife. He also thought that the patient's wife misinterpreted the significance of many of the lab results and that she would have been less frustrated if she did not have immediate access to them.
A second nurse acknowledged that this was a particularly difficult situation, but she felt very differently. She felt that educating the patient's wife about test results was part of providing emotional and practical support to the family, that it fell completely within the scope of her nursing practice. This nurse felt that the wife's access to the results prompted meaningful discussions of issues that may not otherwise have surfaced. "She [the patient's wife] might have actually caught something we missed."
The patient's physician shared his belief that patients and families should not have immediate online access to their test results. He felt that test results are not intended for lay audiences and that immediate access to them only distracts physicians and nurses from providing timely, high-quality care.