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Tracking Patient Results – Risk Mitigation

You order a CBC, and the H&H is a bit low. You sign off on it and never hear back from the patient until you find out that they had a major intestinal bleed which was later discovered.

When I work in the urgent care, I’m taken aback by the number of tests ordered by various clinicians. The in-basket covering clinician, the medical group, and the ordering clinician share the risk.

Test Tracking of Results

As this article by the TDC points out, it’s necessary to have a system in place.

1. Standardize Your Workflow

Each and every patient should get the same treatment. This will hold up well in court if something unexpected happens.

Share your workflow and protocol with all of your patients as a welcome package. Teach them how you track patient results.

2. Track Test Results

I don’t like ordering a CBC when I only want a WBC. But if I order it, then I want to go over all the results.

My best practice is to record it in the chart and leave an audio message which I share with my patient explaining all of their results.

Listening to or receiving that audio message is my way of reconciling that the information was communicated with them.

3. Don’t Rely on the EHR

Software is meant to malfunction – and it will.

If I order a test for someone, my best practice is to bring that person back in for results. A simple phone call will do – but it will be a follow-up appointment to review the results.

4. All Tests Must be Completed

If I order a CT head on my patient and they don’t do it, I’m responsible for any consequence of this. Silly? Maybe.

If I order a test, I want my patient to perform the test in a timely manner, and if they don’t, I will flag them and explain to them the risk to them and to me if a test goes uncompleted.

5. Rejected Labs

How many times have I performed a swab just for it to be rejected by the lab? I used to ignore those. Now the patient gets a new appointment with me for follow-up.

We’ll discuss why it happened, what else can be done, and what it means to the patient.

6. Use the C-Word

Your low leukocytes could be cancer. Your high leukocytes could be cancer. Your low chloride could be cancer. Anything can be cancer. You could be a cancer.

Annoying, but too many physicians avoid the C-word because they think it will protect them or spare the patient’s feelings.

I’m here to be your risk officer, guide, and clinical expert. I can’t change the outcomes of your pathophysiology.

7. Keep Contact Info Updated

I want a phone number with texting capabilities, an email, an emergency contact person, and a mailing address.

When there is a critical result, all of these will be activated. Period. And if I don’t hear back from a patient regarding even a benign abnormal result, they will again be activated.

8. Review Normal Results

Not only review the normal results with the patient but ask them to repeat back to you what they understood from the visit.

This is very easy to do when you run your own private practice. You have the time; you’ve built the right communication skills. It’s worth it, do it.

9. Call the Cops

I had a critical blood sugar value on an elderly lady, which I never expected. I called the sheriff, and they were super helpful and nice.

Call your patient’s local non-emergency police/sheriff line and tell them to do a drive-by.

10. Document it All

Not to overstate the obvious. But I need to document in my chart what happened and what didn’t happen and what was or wasn’t done, and why.

Voice dictation with AWS transcription. For $6, I can talk an hour and have everything go on record.

11. Education & Train Your Patient

I want my patient to understand that when and if I order a test, I’m very serious about it. I have exact expectations and actions I will or won’t take based on that result.

I want to communicate that to my patient before ordering the test and communicate exactly what the test results do and don’t mean.

When patients understand how your process works, they will respect it more and appreciate your thoroughness and, hopefully, one day, keep you from making a mistake.

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