Tracking tests

A key part of running a successful practice is having efficient, reliable and time-friendly systems in place to support medical practitioners and nursing staff with activities related to patient follow-up including test tracking, referral tracking and recalls.

As a practice manager, setting up your practice support systems correctly at the outset will enable you to track and follow up on patient outcomes. While you may not wish to track all processes in your practice there are some general issues to consider:

• The patient’s medical condition – is it serious or life-threatening?
• The risks to the patient of either delaying or not receiving the medical treatment.
• Are the test results abnormal?

In establishing an effective test-tracking system – you need to consider, in conjunction with clinical staff, which types of tests/patients should be followed up and how. While the doctor cannot ‘force' a patient to undertake a test or procedure, it is certainly important that as a practice manager, you are informed by the treating practitioner of any patients who have not had the tests the doctor requested so you can take any appropriate action. Once you have been informed by the treating practitioner of the test/patients to be tracked, set up a system that allows you to record the outgoing test centrally, not just on the patient file. This can be done via a computer-assisted system or paper-based system.

A computer-based system can enable effective central tracking of test results and can include the following capabilities:

• All tests can be ordered electronically, ensuring they are automatically logged on the system.
• Doctors in the practice can action/check off results upon receipt.
• The treating medical practitioner can record action taken and then choose to leave the recall facility open or closed. In this way, the test request can remain active/open until all action necessary has been taken (e.g. it can remain open until the patient has been back to see you following tests).
• When the treating medical practitioner is away, another doctor should be nominated to check results (particularly applicable where there are multiple medical practitioners in a general practice).
• It is easy to nominate a practitioner, or member of the practice staff, to print off any outstanding test audit trail reports each week for each medical practitioner. This allows you to identify tests ordered where no results have been received. The practitioner will decide which patients require follow-up.
• It is important to become familiar with the use of the electronic patient records as this will facilitate ease of test tracking, referral tracking and recalls.

If your practice is not computerised, one way to manage test tracking is to document all tests ordered in a manual spreadsheet recording the following information

• patient’s name
• date
• test ordered
• site of biopsy (if applicable)
• histology signed by courier and date
• receipt of result including date and initials
• reviewed by doctor including date and initials
• patient notified; yes/no and date and time
• contact mode
• action.

Once each action is completed an audit can be performed on a patient whose actions are incomplete, to determine progress of test results.

Alternatively, ‘file isolation’ can be utilised. However, this is dependent on all patient files with outstanding tests being kept in an ‘outstanding test’ section. When the result presents, the file is removed from the isolation area; the test result attached and provided to the doctor for review. A regular audit can be performed on the patient files that remain in the isolation section where no result has been received. It is important that if anyone removes a patient file from the isolation area for any reason except when a test result presents, that a large piece of paper with the patient name be replaced to ensure the patient name remains in the isolation section.

Whether a central register is managed by a manual system or a computerised system, the following should be done:

• A system should be in place to ensure all diagnostic tests conducted on a patient are documented at least in the medical record.
• Results received in non-electronic format can be:
  
  • scanned directly to the 'results in-box' in the patient’s electronic medical
    file where they are managed the same way as if received electronically, or
  • reviewed and initialled by the treating medical practitioner, prior to filing
    in the patient’s medical record and an accompanying action plan
    documented.

Computerized patient records will record the medical practitioner who has reviewed the test result.

• All clinically significant results should be followed up. The results should be reviewed and discussed with the patient, where appropriate, as soon as possible. A recall and reminder system should be in place to ensure the timely notification to patients. This could be either:
  
  • the patient contacting the practice for their results
  • and/or the practice contacting them and asking them to come in
  • or the routine rescheduling of patients with test results for review.
• If a result is significant, the medical practitioner needs to ensure the patient is followed up, rather than relying on the patient to contact the practice to get the result.
• Develop a policy on whether patients are required to schedule an appointment to receive results or whether phone contact is sufficient.
• Document all attempts to contact and advise patients about the outcomes of tests or other information that could affect the state of their health, including any significant findings. Do not wait for the patient to act. In the event of not being able to contact a patient with an abnormal result, staff should try to contact the patient three times, on three different days, at three different times of the day. All attempts at contact, whether successful or not, should be documented in the patient file. Failing telephone contact, a letter should be forwarded by registered mail to the patient’s address and a copy of the letter and receipt placed on the patient’s file.
• There should be a manual or computerised system to enable regular reports of all tests performed and reconciliation with results received, e.g. weekly.
• Patients should be advised of the practice’s system of notification of results, including the patient’s responsibility to follow up results. At booking and each consultation, patient contact details should be checked for accuracy.
• There should be a documented patient reminder system in place, which identifies patients needing regular follow-up, e.g. Pap smears. Patient consent should be obtained before placing them on the reminder system.
• Consider documenting what is told to a patient in relation to follow-up.