Implementing the system

In the pre-result phase, your practice’s responsibility is primarily follow-up and double-checking. If you have ordered a test, consult, or referral, was the patient given the correct instructions on how to proceed to get this test, consult, or referral? Were they given the correct phone number to call, or were they told to call their provider to get an appropriate referral and find out from that provider where to get the service (as is often the case with some health plans)?

Then, was this order put in a tickler file to be rechecked in an appropriate time period? A follow-up check should indicate whether the test was done or whether it is scheduled. If no activity has occurred, the patient should be contacted so that they may be encouraged to get the test, consult, or referral as quickly as possible. This is also a good time to find out if they are having problems with scheduling, or if they misunderstood your instructions; treat situations like this as opportunities to find and correct loopholes in your tracking process.

Good communication with the patient at the time of their visit can help their adherence with your orders. Enlist them in the process; if they understand why you have ordered these things, they are more likely to follow-up with them.

When the test results come back, the second phase of your system begins. In this stage of the process, your practice will focus on the review, documentation, and follow-up of these results. This is the post-result phase.

Now your tickler file can be readdressed to note that the order was accomplished, the patient’s chart can be pulled and the test results affixed to the outside of it for the physician to review. Once the test result has been reviewed, it should be initialed and dated by the reviewer; but there is more to do before it can take its place in the chart and the chart can be filed away.

In the third stage, the practice notifies the patient of the results of the test and follows up on the next steps of the care plan. To effectively address this phase, the practice must develop a system for notification of the patient of all test results – normal and abnormal. This system of notification may be by phone or by mail. If it is by phone then it must include a note in the patient’s chart that they were notified, what they were notified of, when, and by whom. If it is by letter, a copy of the letter is to be filed in the patient’s chart.

If the physician has ordered specific follow-up to the test, this needs to be communicated to the patient. Once again, the information to be tracked will go in the office’s tickler file and the process will begin all over again.

Now the chart can be filed.

Making it work

Some offices find a stamp in the chart is an effective documentation of the second and third phases of their tracking systems. The stamp is a simple set of lines for staff and physician initials in categories such as: received by____; reviewed by____; patient notified by___; filed by___. Each line has a corresponding line for time and date.

Chart documentation should always include the physician’s recommendations for treatment at the time of the patient’s visit and any recommendations which may be made after test or consult results are received. This information is used to help document the doctor’s rationale for treatment.

Consult and referral reports should be handled in the same way as tests, except that physicians may need to call the consulting or referring physician before and/or after the patient is seen. Those calls are also documented in the patient’s record.

Summary

This is a basic tracking system, and each office can amend it to fit their needs. However, key elements need to remain. For instance, it is very important that patients are notified of the results of all tests and consults. This is done so that no results and no patients “fall through the cracks” – it offers a side benefit of increased patient satisfaction with your practice.

If your office uses Electronic Medical Records, that system must have an embedded process which encompasses these basic elements. A process like this will automatically generate “reminders” which go on a task list – this list opens every day with the tasks which must be done that day and the name of the person responsible for them. The tasks are not removed from the daily list until the person responsible completes the task.

This electronic process, like your manual tickler file, helps you and your staff remain faithful in follow-up to each step in the tracking process. As already noted, by increasing the accuracy of your practice’s tracking and follow-up system, you will enhance patient safety while you reduce your practice’s liability.

The Princeton Healthcare Risk Services staff is available to answer questions about tracking and follow-up systems - we also work with offices to institute and/or improve processes. Call us at 1-866-Rx4-RISK.