Manager


Practice


to abnormal results which have been left for patient collection? If the patient decides not to attend and collect the prescription, can it be destroyed after a period of time without a cross-check for clinical need? Such actions could constitute missed ‘flags’, alerting a clini-


cian to non-compliant behaviours. Although patients have the right to refuse treatment, such decisions should be informed by a full discussion of the associated risks and consequences – and it is unlikely that this will have taken place at the initial consulta- tion when tests were ordered or later when results and neces- sary actions were passed on by a non-clinical team member. Another consideration is how the practice deals with hospital


requests for follow-up in general practice? Depending on the nature of the patient’s condition and the clinical risk, it may be that the practice should diarise these actions for appropriate follow-up.


To minimise risk in the actioning of significant results consider: • Reviewing the clarity of instructions given by the clinical teams to receptionists or other non-clinical staff – particu- larly those who are communicating directly with patients about results.


•


Encouraging clinicians to take the time to review patients who DNA for consultations.


• Empowering non-clinical team members to check with clini- cians when unsure of messages – or passing the patient back to a clinician when the patient requires further advice.


•


Encouraging team members to document all contacts and attempts to contact patients, including messages or in- structions that have been passed. This ensures that there is an audit trail in place and that information is available to whomever next deals with that patient record.


•


Incorporating the responsibility for recalls for repeat test- ing within existing call/recall roles.


• Returning uncollected prescriptions to the responsible GP for review before they are destroyed.


RISK 3: GIVING OUT RESULTS Practices will feedback results to patients in a variety of ways. Many will task receptionists to provide results via telephone


whilst some retain that responsibility within the clinical team. A few will still write to all patients with results. There are benefits and risks associated with all these ap-


proaches. For example, a clinician providing results directly to patients over the phone will be able to have a comprehensive view of the results in the context of the consultation. In addi- tion, they will be able to engage in discussion with the patient if they have questions about the results. But using clinical time in this way could reduce the availability of appointments within the practice, resulting in delays and complaints. When a receptionist has been delegated responsibility to


pass on results to patients, an important consideration concerns protected time. Multi-tasking, distractions and interruptions are a direct cause of human error. Does the receptionist know how to deal with questions of a clinical nature? Are they able to re- view whether any results are outstanding? What identity checks are carried out before giving out the result? Could a spouse or parent access results inappropriately – for example when a minor has been seen by a GP on their own?


To minimise risks consider: • Whether the individuals tasked with providing results to patients, if non-clinical, are trained and competent to do so – and that they understand the risks.


•


Asking clinicians to note any urgent flags about the confidentiality of the result as part of their actioning – e.g. ‘result to be given to patient only’ where the patient is a minor.


REVIEWING PROCESSES To support patient safety, practice managers should review each step in their results handling systems and ensure that the practice has a written, shared protocol for managing results. In particular, this should underline the responsibilities of all individuals within the system, and include agreed minimum timescales and mechanisms for viewing and actioning results. By working together to develop a results management


system, clinicians and non-clinical staff can understand the risks within their system and their own important role in mitigating these risks.


Liz Price is the training and consultancy services manager at MDDUS


WWW.MDDUS.COM


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