Well-designed test result systems can help to reduce the likelihood of adverse events and keep patients safe from harm, yet the Medical Protection Society (MPS) has found that 94 per cent of practices have risks associated with their test result system.
Practices use laboratory services on a daily basis, sending off specimens and receiving results, which are checked for abnormalities and actioned as necessary. Is the system you have at your practice robust, effective and safe? When was the last time a test result was lost or not conveyed to a patient?
Sixty three per cent of claims in general practice handled by the MPS are related to failure to diagnose. Many of these can be attributed to system error, for example a test result that is abnormal but not acted on or a test result that is scanned into the wrong patient record.
The MPS undertakes clinical risk self assessments of general practices to identify risk, produce solutions and enhance systems. More than 100 practices were visited in the UK during 2009, of which 94.4 per cent had risks associated with their test results system. The key risks relating to test results are shown in the table (right).
For each of the problems outlined in the table, the following 10 measures explain how to avoid these risks.
1. No record of tests requested and no way to ensure all tests have been reported on.
Practices may consider undertaking an audit of 'ins and outs' of patient samples sent to the laboratory, including blood tests and microbiology samples, to ensure that all results are returned.
2. No tracker system to ensure follow up
Consider introducing either a manual or computerised tracking system to ensure that patients are not lost in the system. A lack of appropriate follow-up may lead to a delay in diagnosis.
3. Patients not informed of abnormal result
Responsibility for acting on the results lies with the practice. Practices could develop a proactive system for dealing with abnormal results, minimising the risk of a test result being overlooked.
The practice should make every effort to contact the patient, and record this, as well as recording if the patient contacts the practice. Do not file a result unless it has been marked as having been dealt with.
4. No system for dealing with multiple tests
The patient should be informed of how many tests will be carried out. Consider providing patients with a list of the samples they have had taken (tick box on a printed sheet) along with the usual timescale.
5. Non-clinical staff entering into clinical discussion about the results
The reception staff should not enter into any clinical discussion about the results but simply read out the doctor's comments, which should be clear, simple and unambiguous.
If more discussion is needed, a telephone appointment should be made with the doctor.
6. Test requests not Read coded
To ensure continuity of care, enter all tests requested onto the patient's computer record using the appropriate Read code.
7. Giving an incorrect result
Prior to giving out a test result, confirm the patient's identity using three identification markers, for example name, address and date of birth.
Clarify the nature of the test results and the date on which they were taken. Encourage patients to keep their contact details up to date.
8. No 'buddy' system if GP away
Ensure there is a robust system in place for reviewing results for absent colleagues.
9. No test result protocol
Develop a protocol, accessible to all staff, for dealing with test results which includes three key elements: testing, processing the results and how to action the results.
10. Clinical staff not reviewing all results
In 4 per cent of the practices visited, the clinician only reviewed test results marked as abnormal, owing to time constraints. All other results were sent to the patients' records unread. This system is unsafe. Clinicians should review all test results.
|Key risks relating to test results|
|Test result risk||Percentage of
with this risk
No record of tests requested and no way to ensure all tests have been reported on
|2||No tracker system to ensure follow up||78%|
|3||Patient not informed of abnormal result||42%|
|4||Not providing patients with test lists (multiple tests)||33%|
|5||Non-clinical staff entering into clinical discussion||24%|
|6||Test requests not Read coded||24%|
|7||Giving out the incorrect result||17%|
|8||No ‘buddy’ system if GP away||14%|
|9||No test result protocol||6%|
|10||Clinical staff not reviewing all results||4%|
It is vital that a practice has a robust and effective test result system and that all staff are fully trained in the procedure.
However, no system is foolproof and if an adverse event does occur, protocols should be reviewed and lessons learnt to prevent a repeat occurrence.
- Ms Wilson is a clinical risk programme manager with MPS education services