This article relates to the CQC key questions: Is your practice safe? and Is your practice effective?
In its inspections of GP practices, CQC key questions include whether practices are safe and providing effective care.
- Is the system you have in your practice to manage test results robust, effective and safe?
- Can you be sure that all test results requested have been returned to the practice?
- How many test results are lost or not conveyed to the patient?
Effective care involves people having their needs assessed and their care planned and delivered in line with evidence-based guidance, standards and best practices, including during assessment and diagnosis. This includes how GP practices manage test results.
Considering whether a GP practice is safe we ask whether lessons are learned and improvements made when things go wrong, and this includes learning from incidents where test results have not been managed appropriately.
Managing test results in general practice can be complex – it involves nearly every member of the practice team, relies on practice systems, outside providers and the need to communicate results to the patient in a timely and clinically appropriate manner.
Failure to follow up test results has been identified as a major problem in primary care settings (see Failure to follow-up test results for ambulatory patients: a systematic review and Safe and reliable systems for managing test results, Scottish Patient Safety Programme).
The resulting effects can be serious lapses in patient care including delays to diagnosis and effective treatment. While some patient harm in general practice can be overt and immediately obvious, harm as a result of poor test management systems may only come to light some months or years later in some cases.
What does a good approach to managing test results look like?
Robust practice protocols and standardised processes can provide strong barriers against risks in the system to protect against adverse events and avoidable harm to patients.
We expect to see that practices have an agreed and documented approach to the management of test results that every member of the practice team is familiar with. This should include:
- Ensuring that all tests requested are documented in the clinical system.
- Having a system in place to track and reconcile tests requested against results received. This should be undertaken regularly to ensure there are no delays dealing with results that require prompt action. A reconciliation system will minimise lost results.
Review of results
- Ensuring that all results (whether within or outside the reference interval for laboratory test results) are reviewed by a clinician with access to the medical record and the training to understand the significance of the result. The reviewing clinician is responsible for ensuring that results which alter patient management are acted on. This may include results within the reference interval for example, discontinuing a medicine or further monitoring.
- Reviewing results in a timely manner, including when clinicians are absent and results are received following requests made by short-term locums.
Documented steps to follow
- Clear, documented, next steps to follow when results arrive at the practice with explicit instructions if administrative staff need to take action. Where it is appropriate for administrative staff to communicate results to a patient, a standardised set of words, terms and phrases should be used. These should be agreed between clinicians and administrators so they can communicate and explain common test results to patients using language that is clear, unambiguous and promotes patient safety. Records must be kept of communication with patients.
- A clear approach and a protocol for informing patients, or where appropriate, families, carers and key-workers, of the results of investigations and patients should be aware of this policy. Results requiring action should always be actively communicated to the patient even if patients were asked to contact the surgery for them. Some practices advise patients that 'no news is good news', so they will only be contacted if the results are abnormal. This may mean vital follow up action is missed by the practice, for example if a test result requiring action is lost and not returned to the practice - the patient will assume that their result is normal. To prevent this, some practices advise patients that they will hear from the practice regardless of the result in X number of days after a test, and they should contact the practice if they have not heard after this date. This process adds an additional layer of protection and also empowers the patient to share responsibility for receiving their results. However, communication of test results should not rely solely on the patient contacting the practice.
- Considering how to identify a patient before results are communicated and determining the practice’s policy on leaving voicemail messages if the patient cannot be contacted.
- Minimising the risk of breaching confidentiality when communicating information by telephone or face to face at the practice. A busy reception area makes it difficult to maintain confidentiality when communicating test results.
Multiple test results
- Ensuring that where multiple tests have been undertaken and results are received back at different times, that all test results are seen and actioned. In these cases there is a greater risk that action for some of the test results is delayed or not undertaken.
- Ensuring that everyone (clinicians and administrative staff) is aware of their responsibilities for managing test results. Training and support for staff, especially those new to the practice, on the day to day implementation of the management of test results is important.
The system should be audited regularly to ensure that it is functioning as it should and whether any changes or improvements are required from the learning gained.
- Failure to follow-up test results for ambulatory patients: a systematic review
- Safe and reliable systems for managing test results, Scottish Patient Safety Programme
Professor Nigel Sparrow is senior national GP advisor and responsible officer at the CQC
More CQC resources
- View the full CQC Essentials series on Medeconomics
- CQC's recommended reading to help practices meet regulations and prepare for an inspection