Results Management Policy

Code: D10.3

Date: 18/06/2014

Revised Date:  23/06/2015, 19/06/2018, 03/12/2018

Purpose:

To ensure that

• Client test results are actioned appropriately.

• The risk of missing significant results is minimised.

• Clients are able to access their results in a timely manner.

Responsible Staff:

Implementation: All staff

Action: All Staff

Audit: Quality Administrator

Audit:

Training Resources:

Linked Policies:

Sensitive tests policy.

Policy:

Responsibility for results:

The practitioner who orders or requests a test or investigation is primarily responsible for ensuring that the result is followed-up.

This policy provides guidance and a consistent method for follow-up of results however, where appropriate, clinicians should use their judgement to ensure clients receive the best service possible.

Follow-Up of results:

Test results shall be delivered electronically to each practitioner's inbox.

Urgent test results may also be received by facsimile.

Practitioners should be aware that there is a risk of non-delivery of test results

Practitioners should check their inbox daily where possible.

Where a practitioner is expected to be absent from work more than very briefly, their results should be followed up by another designated person. The Staff Administrator in conjunction with the Clinical Director shall determine the most appropriate staff member to receive results. Results can be sent to the appropriate inbox using the Practice Management System.

Orphan results are records that have been sent to providers who are not currently active in the system.  This poses a very small risk as critical results should be followed up according to this policy but it is important to check from time to time to ensure that there are no outstanding results that have not been viewed.

The Quality Administrator shall check monthly to ensure that there are no outstanding orphan results in the Practice Management System.

Orphan results shall be redirected either to the patient's usual provider or otherwise to the Clinical Director for action.

Annotation of Results:

To assist in communicating with clients, once viewed, results may be annotated in one of the following ways:

n – result is normal, or so near normal as to make no difference.  The client may be advised that this result is normal.

ISQ – (In Status Quo) though abnormal, the result is stable as compared with previous results and no further action is required.

Ok – An abnormal result, but no action is needed at the present time.

TCI – (To Come In) the patient should be seen to discuss the results. (a letter should be sent or a phone call made to ensure this happens)

Other longhand annotation may be used. Consider setting an alert to ensure that mildly abnormal results are actioned at the client's next visit.

Unmatched provider results

Each day the practice nurse shall check for unmatched provider messages and either:

• Action the result if it is within scope to do so; or
• Allocate the result to the appropriate provider if it is not evidently urgent; or
• Inform a clinician of urgent results as soon as reasonably possible.

Urgent Test Results:

Where urgent test results are requested, the following procedure shall be followed:

• The client shall be advised that the test results are important and that they should call if they have not been advised of the results by 17:00 ( or otherwise whatever more suitable time frame shall be determined)

• A clipboard is kept at reception. When urgent blood results are sent, a note with the client's name and the nature of the urgent tests should be fixed to the clipboard.

• Urgent blood test results will usually be received by facsimile. Upon receipt, the results should be made available to the requesting practitioner by affixing them to the reception clipboard.

• If any results remain on the clipboard at 17:00, the receptionist shall ensure that the results are drawn to the attention of the next doctor to become available.

• If results are not received (as per the list on the board) the receptionist shall ask the practice nurse to obtain the results, or otherwise check the likely available time with the laboratory.

• If it is likely that results will not be available before 17:00, the referring practitioner shall either:

1. Make arrangements for follow-up with the 24 Hour Surgery, a practice colleague or the Acute Demand Service

2. Affix their own personal contact details to the request form and follow-up the results personally.

Potentially Serious Results

Where a result is important, but likely not to be available until the following day or later, requesting practitioners should set themselves a task in the PMS to ensure the result is not forgotten.

Acceptable alternatives include written reminders and the use of alternative organiser software provided it complies with the Health Information Privacy Policy.

Communicating Results

Results may only be communicated in accordance with the Health Information Privacy Code.

In general, except for results specified in the sensitive tests policy, clients may call and ask to be given the results of their tests by phone. Such requests shall be taken by the practice nurse.

Both when a sample is requested AND when it is taken, clients should be advised how and when to call for results.

Staff ordering tests, staff collecting samples and reception staff taking payment for blood tests should check that the address and contact numbers on file are up to date.

Clients should be advised that although we will attempt to contact them if there is a serious abnormality, they should NOT assume that no news is good news. Instead, they should call and ask to speak to the nurse three working days after the test (or other more suitable time if appropriate) to ascertain the results and any action that should be taken. An outbox document (RESULT) is available to hand to clients where there is concern about their ability to understand the explanation.  All rooms shall include a notice about test results informing patients that they should check their results in person or online if they have heard nothing in a few days.

Where it is clinically appropriate, clients should still be called with results though they should still be advised to contact us if they have not heard anything within a specified time scale.

A recent Health and Disability Commision investigation has led to the suggestion that all result abnormalities should be advised to patients.  Staff should note that only laboratory tests are routinely posted on the patient portal.  Radiology results will need to be advised manually.  Given the varied nature of humans and the great number of possible abnormalities, it is currently practice policy to inform patients of abnormal results only when they are:

• of relevance to the symptoms being treated; or
• may indicate that treatment may be of significant benefit regardless of symptoms.

Examples might include the common situation where arthritis is found in a joint close to the one being imaged.  This is common in the hand.  It would be appropriate to inform the patient routinely if the joint is symptomatic, but not if is is just an incidental finding.  The presence of erosive arthropathy however implies that even if not symptomatic further treatment is required and the patient should definitely be informed.

Change Log:

04/12/2018

Added section on unmatched results.

23/06/2015

Policy reviewed.

Added section on orphan results and audit schedule for this.

Added Quality Administrator Role.

19/06/2018

Policy Reviewed

Added comment on HDC.

Added requirement for rooms to have a notice about test result policy.