Having a safety net: tracking clinically significant tests

Jan 12, 2017

A reliable system for dealing with tests and results is an essential tool in every practice, and will support both doctors and practice staff in providing optimal patient care and management.

Due to the special relationship patients have with their doctor, the practice needs to ensure test results are tracked, monitored, communicated to patients and the appropriate actions are taken. Some patients may not turn up to obtain their results for a number of reasons – fear, cultural background/expectations or beliefs, forgetfulness or misunderstanding.

A good test tracking system can provide a safety net for your patients and ensure they have the tests they need, the relevant doctors are notified and recall actions are taken where required. It is a central piece of patient management and will enable anyone in the practice to access the status of a test or result, even if they can’t discuss results with the patient.

This is why it’s worth taking time to set up a system that automates the process and ensures clinically significant situations are adequately addressed. The process needs to be documented and everyone in the practice, including doctors, should be aware of and participate in it.

The steps that need to be taken to follow up a patient when you have recommended or carried out a test depends mainly on whether the results are likely to be clinically significant. Your practice should have a centralised system in place for tracking tests and monitoring and actioning clinically significant tests and results. It should be designed in a way that anticipates that individual cases will require different levels of follow up depending on the clinical significance of the test and/or results.

It’s important when you recommend a test to a patient that you advise them of the reasons for the test, the importance of having it done, arrangements for obtaining the result, and the potential consequences of not having the test.

Setting up the system: key points

According to the RACGP, practices should consider these key points when setting up a computerised or paper-based tracking system:

  • A documented system for the follow-up of tests and results, with a strong focus on risk management
  • Mechanisms for dealing with normal results, abnormal results (urgent and non-urgent) and important tests/referrals
  • Mechanisms for the follow-up of clinically significant tests and results
  • How tests and results are communicated to patients.

Processes for tracking clinically significant tests

Decide on actions when:

  • a test is ordered
  • a patient doesn’t present for a test within a specified time-frame
  • results are received (whether normal or abnormal)
  • results are not received within a specified time-frame
  • results are communicated to a patient (and how they are communicated)
  • a patient needs to be recalled to discuss results
  • a patient doesn’t attend the practice to discuss results within a specified time-frame.

Recalling a patient to discuss test results

When the test result is received, the doctor needs to review the result and initiate the next action. Practice staff can facilitate reviews by printing an audit trail report from a computerised tracking system for each doctor to update, or following up with individual doctors from a paper-based tracking system.

The doctor will identify those who need to be contacted to arrange a follow-up appointment to discuss the results.

Attempting to contact a patient

A phone call or SMS are the usual way of communicating with a patient who needs to be recalled. Before any information is sent via SMS you need to obtain and document patient consent. Your practice should inform patients that text messages are used as a reminder service for recalls through your privacy policy and/or the practice website.

You should ensure that you have the correct mobile number and document each time a phone call is made or a text is sent to a patient – up to three calls may be required at different times of the day. Texts should not include any clinical information such as a description of particular tests results that need to be followed up or the results of such tests. The message should simply request that the patient contact the practice, as well as indicate (where appropriate) the level of urgency. For more information, read our factsheet ‘Recommendations when using SMS messaging’.

If using a computerised system, only use the ‘notified tab’ when the patient has been given the result.

The final attempt – a registered letter

If phone calls and SMS have been made without success, Avant recommends, if clinically appropriate, that a final attempt be made via registered letter that requires the patient’s signature on receipt. You should keep a copy of this letter and any supportive material. The letter should communicate the importance of the test and the risks of not proceeding with the test or an appointment to discuss the test results

Further reminders

Don’t forget to include reminders for repeat tests or consultations in your recall system.

More information

Criterion 1.5.3 System for follow up of tests and results, view RACGP’s Standards for general practices (4th edition).

We have a number of resources which you can use to set up tracking systems. Visit our website.

Share your view

We welcome your feedback on this article – email the Editor at: editor@avant.org.au