Introduction The World Health Organisation’s Patient Safety Forward Programme identified a failure to follow-up on tests being critical to patient safety. Oxford University Hospitals’ (OUH) Trust aim to tackle this via their endorsement system. Trust policy at OUH is that all requesters of diagnostic tests are required to endorse at least 90% of results within 7 days of them being issued. However, this has consistently not been achieved across multiple specialities at OUH. We found there were no official rules to mandate the policy and several serious incidents have been reported, where the untimely and/or lack of results endorsement has compromised patient safety. The current system is such that when a diagnostic test is requested, the result will go into the inbox of the requester and also the named consultant of the patient; where they can endorse the result.

Aims and objectives of the research project or activity We sought to identify a specialty with low endorsement rates and explore why their rates were so low and how we could help to improve this.

Method or approach We obtained detailed speciality-wide data regarding results endorsement and identified cardiology to have chronically low endorsement rates. We prepared a survey and sent it out to all foundation doctors within the trust, and clinical staff working in cardiology at the John Radcliffe (JR) Hospital to gauge their opinions on endorsement and any suggestions on how we could help them increase their endorsement rates.

Currently, only the requester and the named consultant can endorse results. Following the survey results, we worked with the digital team to add an ‘endorse’ button onto the electronic patient records that anyone can press once they have reviewed and actioned patient results. We arranged a meeting with staff in the cardiology wards at the JR and showed them how to add the endorse button, as well as educating them on the importance of results endorsement.

Findings During the month of October 2023 (before our intervention), endorsement rates within cardiology were 58%. During the month of November 2023 (after our intervention), endorsement rates were 61%. We obtained further opinions from cardiology staff and discovered that clinical pressures regularly prevented them from endorsing results. As there is an audit trail associated with results endorsement, there is a fear of legal responsibility when putting one’s name to a result; more so when there are clinical pressures affecting an individual’s willingness to confidently endorse a result. Furthermore, cardiology staff stated that although anyone could now easily endorse results, there was no obvious clinical benefit in doing so, thus they didn’t feel motivated to take the time to properly endorse results.

Key messages We discovered that not only is further education on results endorsement required, but our project also highlights the importance of ensuring staff feel comfortable enough to endorse results. There is an apparent belief that endorsement has no clinical benefit and puts you in a potentially legally compromised position. We are working with our stakeholders to try and improve communication regarding the benefits of results endorsement and have also received input from the legal team that there is a ‘no-blame’ culture within the Trust, thus individuals shouldn’t feel worried about endorsing results. Overall, this project has highlighted that making improvements to the computer system only slightly increases endorsement rates. There should be work put into the human factors, exploring people’s apprehensions and how they can be alleviated.