At the second practice, the physician ordered laboratory tests using a special laboratory billing slip. The nurse made and kept a copy of this slip, sending the original to the laboratory. Practice personnel recorded the laboratory tests in one of 2 logbooks, “path” and “other.” When results came back they were checked off in the logbooks. The books were checked daily (other) or monthly (path) to catch those that were missing. As results came in, the nurse checked them off the billing slip, and when all were back for a particular patient she took them to the physician along with a test results information sheet. The nurse also checked the billing slips every 3 days for most laboratory tests and every 5 to 6 days for “path” and called the laboratory when results were not back in a reasonable period of time.
The audit revealed that 100% of the laboratory tests were listed in the logbook, and 100% of the laboratory test results received were recorded. However, 15% of patients’ charts did not contain the results even though the reports were marked as having been received.
Steps 2 and 3: Notification and Documentation At the first practice chosen to evaluate these steps, the physician instructed the nurse to call all patients with abnormal results to give them instructions regarding follow-up. Patients with normal results or follow-up appointments were not contacted. Those without follow-up appointments were sent a copy of the laboratory report along with any necessary comments from the physician. Calls and mailings were generally handled on the day after the results were received by the clinic. For documentation, the nurse initialed and dated the laboratory form and placed it in the chart.
Of the 20 cards we mailed to patients, 13 were returned (65%). Of these, 92% indicated they had been notified of test results. Fifty-four percent of these had received the results within 1 week, 38% within 1 to 2 weeks, 0% within 2 to 3 weeks, and 8% within 4 weeks after the test was performed. Ninety-two percent of the respondents were satisfied with the method used to notify them of their test results, and no suggestions were offered for improvement. The audit revealed that 40% of the charts had inadequate documentation of patient notification. Of these, 50% of the test results were not initialed, and 50% were not dated.
At the second practice, the physician initialed and dated the laboratory test results form and wrote a note on it to the patient regarding the results. This was copied and mailed to the patient with a generic form describing commonly ordered tests and what they indicate. Patients could call for clarification. The original laboratory report was placed in the chart. Patients were only contacted for urgent matters or if a specimen had to be recollected. For documentation, laboratory sheets were initialed and dated by the nurse and marked “mailed” at the time they were copied and sent to the patient.
Of the 20 cards mailed to patients of the second practice, 9 were returned (45%). Of the patients who responded, 100% indicated they had been notified of test results. Seventy-five percent of these had received the results within 1 week and 25% within 1 to 2 weeks after the test was performed. All of the respondents were satisfied with the method used to notify them of their test results, and no specific suggestions were made. The results of the audit of the second practice for documentation of patient notification revealed 95% of the charts had adequate documentation of patient notification.
Step 4: Follow-Up Tracking At the first practice chosen to evaluate this step, the clinic receptionist had a list of patients scheduled each day to follow up abnormal results. If the patient did not show up, the nurse was notified and an attempt was made to contact the patient by phone or mail. A note was written in the chart that this had been done. If the situation was felt to be serious or if the patient failed to follow up after several attempts, the physician was notified. The results of the audit revealed that 40% of the charts had inadequate documentation of follow-up tracking. Several problems were identified. The longer the delay in recommended follow-up, the less well the tracking system worked. Situations in which the first attempt to contact the patient was unsuccessful were often lost to further attempts at follow-up. There also appeared to be no way to track outside consultations, and the method required a fair amount of judgment by the office staff.