Hospital-wide identification of overlooked anti-HCV-positive patients through a medical safety intervention: A quality improvement study

Objective: Positive antibody to Hepatitis C virus (anti-HCV) test results do not always lead to appropriate specialist evaluation and follow-up. Because failures in the follow-up of abnormal test results remain an important patient safety concern, this study evaluated a medical safety intervention designed to identify overlooked anti-HCV-positive patients and promote appropriate follow-up.
Methods: Patients with positive anti-HCV antibody test results recorded between July 2010 and June 2020 were identified from the electronic medical record system. Patients who had not consulted the gastroenterology department after confirmation of anti-HCV positivity but continued follow-up at our institution were included. The Department of Medical Safety Management notified responsible physicians and recommended confirmation of hepatitis management status and specialist referral when appropriate. Outcomes following notification were retrospectively evaluated.
Results: Ninety-nine patients (54 men and 45 women; median age, 75 years) required confirmation of hepatitis management status. Following physician notification, documented responses were obtained for 86 patients (86.9%), and 55 patients (55.6%) were referred to the gastroenterology department. Seven patients (7.1%) subsequently initiated direct-acting antiviral therapy, whereas eight (8.1%) declined referral. No documented physician response was identified in 13 patients (13.1%).
Conclusions: A hospital-wide medical safety intervention successfully identified patients with overlooked anti-HCV-positive test results and promoted physician response and specialist referral. Positive test results may remain unaddressed across departments and over prolonged periods. Medical safety-led review and physician notification may represent a practical strategy for improving follow-up of abnormal test results, particularly in institutions without automated alert systems.