Managing test results in general practice is complex. It involves every member of the practice team as well as relying on outside providers. It is vulnerable to human error and there is significant potential for mistakes to occur. Suzanne Creed, clinical risk and education manager at Medical Protection, examines some of the key risks in the handling of test results
When was the last time a test result was lost or not conveyed to a patient? Can you be sure that there are no reports in the system that you have not seen or acted upon?
By developing and implementing robust risk management policies and procedures, practices can reduce the risks and thereby prevent avoidable harm to patients.
Medical Protection has been undertaking clinical risk self-assessments (CRSAs) in general practice across the UK and Ireland since 2000. A CRSA is a unique, systematic approach used to identify potential risks within a practice and develop practical solutions to mitigate these risks; ultimately improving the quality of patient care and reducing the practice’s exposure to unnecessary risk.
In this article we will look at some of the key risks identified as part of the CRSA programme in Ireland, and outline some strategies to mitigate those risks.
Key risks
No record of tests requested
One of the challenges for practices is ensuring that all samples sent off to the laboratory are returned as results. All clinicians when requesting and taking blood samples should clearly document what has been requested and what has been actually taken in the patient’s clinical file. This will allow for any outstanding results to be clearly identified. Simply entering “for routine bloods” is not good clinical practice. It is the GP’s responsibility to check the results once they come in and act on them. It is a good idea to regularly review your practice’s system, perhaps undertaking an audit of ‘ins and outs’ of patient samples, to ensure that all test results are returned to the practice.
Clinical review of results
The requesting clinician should review and electronically sign each result in a timely fashion – ideally the same day or next working day. Practices should develop a robust ‘buddy system’ to manage results when a clinician is absent or on leave. All tests results, both normal and abnormal, should be reviewed by a clinician. Although it is usually abnormal results that require action, sometimes normal results may also require actioning – for example, a normal haemoglobin that is falling, or a normal PSA that is rising.
Not informing patients of abnormal results
Responsibility for actioning test results lies with the practice – do not assume that the patient will contact the practice to find out if any action is necessary. It is good practice to have a system for ensuring that the desired action is carried out, eg a follow-up test, investigation or review, by contacting the patient.
The practice should make every effort to contact the patient and record these attempts. Do not file a result unless it is marked as having been actioned. When a patient has contacted the practice for a result, this should also be noted in their record. The time of referral or arranging investigations is an ideal time to confirm patient details, particularly their mobile phone number. This may save some time later when trying to contact the patient with results.
No tracker system to follow up the patient
Do you have a reliable method of checking that the patient has attended their follow up appointment? Failure to adequately follow up with a patient may lead to the delay in diagnosis of a clinically significant condition. Practices should consider having a system for the effective tracking of patients who, the GP feels, require monitoring or follow up.
Top tips
• Document all tests requested and taken. Confirm all requested tests have returned.
• All results should be checked by a GP (not the practice nurse).
• Review all results in a timely fashion; have a written 'GP Buddy' system to cover part time GPs or those on annual leave.
Conclusion
Managing risk around test results in general practice is everyone’s responsibility. It should become part of everyday activities within the practice and involve both clinical and administrative staff. The whole practice has a part to play in recognising potential risks and mitigating them. Looking closely at existing systems will always bring into view new ways of working and, most importantly, improving patient safety.