Keeping track of test results
When systems don't work, it's often because they're too complicated and time-consuming.
Every practice should adopt protocols for handling lab, X-ray, and consultants' reports.
Staffers should not file any incoming reports unless you have reviewed and initialed them.
Q:We've had difficulty tracking results of diagnostic tests and specialist referrals in my internal medicine practice. Any suggestions?
A: You're right to be concerned: The liability implications of failing to keep track of tests, consults, and referrals are obvious. A misplaced test result can set in motion a chain of events that results in a delayed diagnosis of cancer. Or failing to follow up when a patient skips a specialist's appointment can cause a patient's condition to deteriorate. Although it's a patient's responsibility to comply with medical instructions, juries usually assume that a physician has superior knowledge and should take steps to ensure that patients understand the importance of compliance.
You can achieve good follow-up with either a paper or computer system, as long as each is user-friendly. When systems don't work, it's often because they're too complicated and time-consuming, or because your staff hasn't been properly trained in the methodology and the importance of follow-up care.
Every practice should adopt strict protocols for handling lab, X-ray, and consultants' reports. Create a "tickler" system, either on computer or with a logbook. Record every consultation or test ordered, along with the date the report is due.
For efficiency, it's best if the order is directly connected to the tickler so that staffers don't have to make a separate entry. Some computer programs can transmit a doctor's order directly to a reminder file. You can design a paper system to do the same thing.
Making sure reports are returned on time is another important step. Many software programs track the estimated turnaround time from the date a test was ordered and remind you each day when it's due back. If you have a paper system, a staffer should file the test order on the day the test is due back. The system should be readily accessible for all staffers who need to be reminded.
Train your staff to review the follow-up paper or computerized information every day and let you know when results aren't reported on schedule. Appoint a staffer (and a backup) to be responsible for contacting labs or radiology practices with reminders. Have her document her efforts.
You also need to follow up with patients who fail to show up for appointments with specialists you referred them to. Physicians can often prevent this problem with informed consent conversations about the risks, benefits, and alternatives of the treatment or test you recommended. It also helps to make the appointment for the patient and give her an appointment slip.
If a patient fails to make or keep an appointment with a specialist or lab, your staff should telephone her, and follow up in writing, if necessary. When the patient has a serious problem, you may opt to send a certified letter, return receipt requested, and keep a copy and the receipt in the chart.
Sometimes the problem isn't with the patient: Say she kept the appointment, but the consultant's report got lost in your office. To avoid this, your staff should be instructed not to file any incoming reports unless you've reviewed and initialed them. Instruct the person who opens your mail or handles faxes to clip all new reports to patients' charts, and to place the charts on your desk for review.
Lee Johnson. Malpractice Consult: Keeping track of test results.
Jun. 20, 2003;80:76.