ADVICE RESULTS HANDLING
Is your practice system for results handling fail-safe? Liz Price highlights three common areas of risk
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S a practice manager it is likely that you will be respon- sible for overseeing the effectiveness and safety of clinical systems. In the absence of standardised results
management systems within primary care, practices often de- velop their own processes for managing tests and results. This has commonly resulted in systems that lack clarity on clinical and non-clinical boundaries and responsibilities, and can create conditions within which a number of errors may occur. Here I highlight three of the most common risks associated with
results handling systems. Mismanagement of results can have serious implications on patient safety and lead to adverse events, complaints and claims, but there are strategies to reduce risk.
RISK 1: MULTIPLE OR MISSING RESULTS Consider the case of a patient who attends a practice with symptoms which a GP decides warrant further investigation. The patient is referred to a treatment room nurse for blood tests to be undertaken. Once the bloods are taken, the patient is asked to contact the practice later that week to receive his results. The patient phones the practice as requested and a recep- tionist checks that the results are back and tells the patient that the GP has marked his results as satisfactory. The patient ends the call feeling reassured that there doesn’t seem to be anything wrong and that his symptoms will eventually resolve. However, the symptoms worsen and the patient returns in
four month’s time. When the GP checks the previous consul- tations, she realises that one of the requested results is not available within the record and sends the patient for re-testing. It is unclear why the result was not returned to the practice; however this failure could result in a delayed diagnosis for the patient which could result in a poorer prognosis and additional unnecessary suffering. This scenario is not unusual. Other common errors relating to multiple results (see also page 14 of this issue) include clinicians filing the result without required action, or results for the same patient being seen by different clinicians leading to fragmented views of the patient’s overall condition.
To minimise risk consider: • Training for non-clinical staff in understanding tests and results.
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Undertaking regular audits to assess the number of tests which are not returned – this can vary significantly by practice. This will allow you to make a judgement about the frequency of the problem and allocate resources to mitigate the risk.
• Implementing a system where all specimens taken are matched with the corresponding result received at the practice. These matching systems can allow receptionists to see clearly when there are any outstanding results – information which is useful to pass on to the patient and for prompting investigation into the reason for the delay or non-return of the result.
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Building continuity within clinical systems to reduce risk – and also increase efficiency. For example, when the clini- cian who requests the test also reviews the results, this can lead to better situational awareness and prevention of harm.
RISK 2: ACTIONING OF SIGNIFICANT RESULTS The majority of results in general practice are work-flowed and viewed electronically. When a clinician is concerned about a result, they may direct a non-clinical member of staff to take action. Required actions can include contacting the patient to make an urgent or non-urgent follow-up appointment, asking the patient to collect a prescription for treatment, or informing a patient of the results and advising that they be rechecked after a period of time. There are multiple opportunities for error here. Has the level of urgency been effectively communicated
between clinician and non-clinical staff and is the message to be passed to the patient clearly understood? If not, this could result in the patient receiving inaccurate information or a receptionist being placed in the difficult position of feeling pressurised to interpret a result. Does the patient attend for a follow-up appointment? If not,
are DNA patients reviewed to check whether the practice has initiated contact? The fact that a patient has not attended for an appointment can be a ‘positive’ within a busy morning surgery – however if the record is not checked by a clinician, required ac- tions may be missed. What happens to prescriptions connected
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SUMMER 2013 ISSUE 8
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