1. Results Handling

2. Aim and Measures
Aim: 100% of all lab results will be ‘actioned’ within seven days
Was a definitive decision recorded by a clinician on EACH test result within seven calendar days of being received?
Have the decisions for EACH test result been ‘actioned’ by the practice including appropriate recalls and tracking of the actions? (if no actions are required record at N/A)?
Was the patient informed as instructed? (If no instruction record at N/A)?
Overall Compliance
Firstly looking at the AIM and how things will be measured
Questions used for the key ACTIONS
We are interested in and ‘All or Nothing’ approach i.e. whether ALL ordered tests for EVERY patient match to positive answer for ALL of the questions.

3. Results Handling

4. To discuss and feed back Small groups
What have you done that worked well?

5. Results handling change ideas

6. Registered patient has blood test (FBC, eGFR, LFT or TFT) AND nurse sends results handling process SMS to patient to advise of results process.
Normal result
Abnormal result
Does not have MMH
Has MMH
Use .normal quick key (blood test result normal. No significant cause for symptoms identified. Return for a review if needed) and file result. The patient can view their result using MMH.
Use .normal quick key (blood test result normal. No significant cause for symptoms identified. Return for a review if needed) and forward result to ZL/ HH inbox. The nurses will routinely check their inbox and the result to the patient.
Patients can expect to receive normal blood test results within 5 working days.
Add a comment in to the blood test result that the patient can understand and then file. The patient can view their result using MMH. Set appropriate recalls for follow up care/ ask nurse to set recalls for follow up care.
Add a comment in to the blood test result that the nurse/ reception staff can understand and forward result to ZL/ HH inbox. The nurses will routinely check their inbox and the result and let the patient know about the follow up required. The nurse will set appropriate recalls for follow up care.
Patients can expect to receive normal blood test results within 5 working days or sooner if indicated.

8. To discuss and feed back Small groups
What are you going to do next?

9. Possible areas to think of?
Systems
How does practice ensure results are work-flowed, reviewed and acted on in a timely manner?
Actioning emergency results from laboratory?
Practice agreed standards for reviewing results in a timely manner?
Tracking
Tracking system for reconciling samples out with results returned and ensure appropriate follow-up?
Training
How are staff, including locums, trained in the results handling system?
Patient involvement
How does practice help patients understand results handling system?
How record that patients notified and actions require?
Portals?

10. Key Change Ideas from Previous Years
Standardized comments on lab results
Interpretation of result (normal, acceptable, stable, abnormal)
What action (if any) is required?
Development of ‘key words’ to make annotation easier and quicker
Education of doctors in barriers to dealing with results in a timely manner.
Contacting patients
Keeping patient details and preferred contact method up to date - everyone
Poster in waiting room asking clients to check for results if no communication to them within seven days of doing tests
Doctors to send a text (or post letter) for all results and actions?
How does this fit with patient portal?
Able to get the benefit of ideas that other practices have tried in previous years – useful place to go for ideas

11. Locums or absent doctors
Policies
Update practice policy on results handling policy – expectation that all results will be annotated not just signed
Surveyed patients as we saw them on their knowledge of our current process
Update information on ‘results process’ for patient education
Team approach
Getting the GP team to understand how their action/notes on a result can help the nursing team communicate clearly with patient re meaning and actions required
Enforce inbox standards sent to doctors – “top 10 inbox messages sent to nurses that waste their time”
Locums or absent doctors
Allocating someone to monitor inbox – this system worked well and all results were dealt with in appropriate timely manner
Lead clinician audited inboxes/results daily of any locum doctors, especially weekend staff