Test results

IMG_0811MPS analysed data from 107 Clinical Risk Self Assessments (CRSAs) undertaken in practices in 2014. Risk associated with test results was found in 72% of practices, which was the sixth riskiest category, after confidentiality, prescribing, communication, health and safety and medical records.

Locum GPs may be particularly concerned that they organise blood tests and x-rays for patients, and then leave the practice.

  • How can they be sure that the patient went for the test?
  • How can they know that the results came back to the practice and were seen?
  • Was appropriate treatment offered or referral made on the basis of the results?

Locum GPs may wonder what happened to the patient and whether their differential diagnosis was correct and understandably, this can play on their minds.

Locum GPs may be concerned that a practice’s test result protocol has flaws, that there could be the potential for results to be missed or not acted upon.

What should locum GPs do to raise any concerns they may have and how can they ensure that their part in test requesting and result handling is as safe as possible?

Dr Rachel Birch, MPS Medicolegal Consultant and Sessional GP, provides further advice on what locum GPs might do to minimise any risks.

Before starting work at a practice

  • Ask the practice to send you a copy of their test result protocol so that you can be familiar with it in advance. This should outline clearly the process of requesting, reporting on and actioning test results.
  • Ask for further information when you arrive at the practice if the process is unclear.
  • If the practice expects you to review test results, consider whether it is safe for you to do so.
  • You should have dedicated time to review test results and an understanding of the practice’s processes. There should be a nominated GP with whom you can discuss any abnormal results and to whom you can hand over the care and follow up of a patient.
  • If you feel that it would be unsafe for you to review test results, for example, if you are only at the practice for one day, then raise this with the practice.

Ordering tests

  • If delegating the task of phlebotomy, ensure that it is clear which bloods are to be taken.
  • Inform the patient which tests are to be done and consider providing patients with a written list of the samples they have had taken.
  • Ask the patient to telephone the practice to obtain the results and clarify with reception staff that all results are back. Although it is the practice’s responsibility to notify patients if abnormal results require action, asking the patient to contact the practice can add an extra layer of safety to the system.
  • Find out how long it takes the local laboratory to report on tests and whether there is a long waiting time for radiology reporting- you can then reliably inform the patient how long they will have to wait for their results.

Handover

  • If you are concerned about a patient, ask the patient to return to a particular GP and consider booking them an appointment for follow up.
  • Ensure that you pass relevant information on to the named GP, so that he or she can take appropriate action on receipt of the results and record this in the records.
  • If subsequent action is necessary on receipt of a normal result, highlight this to the patient and the patient’s usual GP. For example, if you have taken a ferritin level, to see if the patient should stop Iron tablets, then this would need to be highlighted- otherwise there may be the danger of continued Iron treatment despite a normal result.

Reporting on test results

  • Ensure that you understand how the practice responds to results that require further action.
  • There should be a reliable method of communication between the doctor and the administrative staff so that abnormal results are followed up. Many practices use document management software so that doctors can easily alert administrative staff that an action is required.
  • For any abnormal result the practice should have a system whereby the patient is contacted and asked to make an appointment with the doctor or have a test repeated.
  • Practices may have a buddy system, whereby one GP will receive and comment on a doctor’s blood results if he or she is absent on leave. If you are covering a long term locum, enquire as to whether you are expected to be a doctor’s “buddy”.

Learning from cases

  • With the consent of the patient, ask the practice to notify you of particular results that you want to follow up.
  • It is useful for education purposes and for evidence at appraisal to reflect on a patient’s care and learn from the results of investigations. Most GP practices will be only too happy to provide feedback on patients (with the appropriate consent).

Raising concerns

In the course of your work at a practice, you may develop concern that a practice’s test result process is unsafe. For example, there may appear to be an unacceptable delay between results coming back and being reported. You may have had to contact the laboratory for certain results and be concerned that not all results are coming back to the practice.

  • The GMC advises that doctors should take action if patient safety may be compromised by inadequate policies or systems.
  • You should raise any concerns, both verbally and in writing, with the practice, if you have concerns about any aspects of test requesting and reporting.
  • You should seek reassurances that your concerns have been appropriately addressed.

Reference

GMC. “Good Medical Practice (2013)” Para 25b.

The Sessional GPThis article first appeared in The Sessional GP magazine June 2015.

 

 

 

 

 

 

Charlotte Hudson

Writer and editor at MPS. MPS’s educational risk management workshops, ‘Mastering Professional Interactions’ and ‘Medical Records for GPs’ provide further information on the risks to patients and doctors when patient care passes between doctors, and on good record-keeping. They are free as a benefit of membership to MPS members too.

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3 Responses

  1. Sam
    With the recent guidance from both the General Practitioner Committee and the Consultants Committee of the BMA that 'the ultimate responsibility for ensuring that results are acted upon, rests with the person requesting the test and that delegation of results to someone else can only be done if they accept by prior agreement' - where does a locum stand legally when requesting results which they will not see? Do we assume that the Partners of the GP in which we work accept this responsibility by taking locums on, or does there need to be more of a written agreement should this be tested?
  2. Jenny Wilson
    as a partner (former locum) I would expect to see and act on locums test results. Following the guidance above is obviously common sense but the crucial thing is to document well all that has been said, your thoughts, your plans and what has been said to the patient, and always always always, as any of us whatever our role, partner, salaried, locum or trainee, emphasize to the patient they must contact the practice for their results as lack of contact by the practice can never be assumed to be because the result is normal
    • Sam
      Yes, I agree with the heavy emphasis on safety netting but I am unclear about the position should a result of a test ordered by a locum get mislaid/missed or was not acted upon and the patient came to harm as a result - who would be liable in the eyes if the law? Even if a locum had safety netted accordingly they ultimately ordered the test and with this guidance in mind would therefore be responsible for the result?

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