Out-Of Hours Reporting of Laboratory Results

Homerton University HospitalNHS
NHS Foundation Trust / Management Procedure / MP-GEN-P054
Pathology Department / Out-of-hours reporting of laboratory results

Out-of Hours reporting of laboratory results

Pathology Department

HomertonUniversityHospital

NHS Foundation Trust

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TABLE OF CONTENTS

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1PURPOSE / CLINICAL RELEVANCE

2RESPONSIBILITIES

3DEFINITIONS

4RELATED DOCUMENTS

5LABORATORY PROCEDURE

6APPENDIX A: GP AND OUT OF HOURS SERVICE PROVIDER GUIDANCE

7REFERENCES

1PURPOSE / CLINICAL RELEVANCE

Following the reporting of several serious untoward incidentsrelating to the inability of laboratory staff to find an appropriate primary care physician to acton a life-threatening or markedly abnormal test results, the Royal College of Pathologists has produced guidelines for laboratories to follow when reporting critical results to GP’s outside of normal hours. Local incidents where the GP out-of-hours service provider for HomertonUniversityHospital will not accept results have also been recorded.

Research quoted by the Royal College of Pathologists identifies that the problems in reporting and acting on markedly abnormal laboratory test results fall intothree main areas:

laboratory staff not knowing whom to contact when a GP surgery is closed and notknowing how to make that contact
staff at the out-of-hours provider not appreciating the importance of the abnormal resultand being unwilling to accept responsibility for the result
staff at the out-of-hours provider being unable to contact the patient and/or unable toaccess patient records as part of the corrective action.

The out-of-hours provider will usually have no previous knowledge of the patient and limitedaccess to patient records. The abnormalities being communicated are, by their very nature,acute and potentially life-threatening. Laboratory staff play a key role in interpreting the results in the context of other information available in thelaboratory, and in guiding the out-of-hours doctor receiving the result.

2RESPONSIBILITIES

It is the responsibility of pathology services to work with out-of-hours providers and PrimaryCare Trusts (PCTs) / GPs to ensure that adequate local arrangementsare in place to deal with the reporting of abnormal test results out of hours. It is normallyoutside the remit of the professional role of clinical laboratory staff to contact patients directlywith abnormal results.

The responsibility of the laboratory staff is to communicate any markedly abnormal test resultto the clinical team – either to the GP who made the request or to the out-of-hours provider. Itis the responsibility of the requesting clinical team to review results of tests that they haverequested and have proper handover arrangements in place to review and act on abnormalresults after hours, in the best interests of the patient.

The PCT or commissioning body has aresponsibility to ensure that adequate out-of-hours cover arrangements are available, andthat details of these arrangements are communicated to the laboratory.

3DEFINITIONS

“Out of hours” refers to the period of the working week when GP surgeries are unstaffed(often 18:30–08:00 hours every weekday and all day at weekends and bank holidays, thoughsome surgeries and walk-in centres/urgent care centres are now open 08:00–20:00, eitherweekdays or every day) and/or responsibility for patient care has been passed from thenormal GP to an out-of-hours provider.

A markedly abnormal laboratory test result is a result that may signify a pathophysiologicalstate that may be life-threatening or of immediate clinical significance and that requiresurgent action. A list of such markedly abnormal laboratory test results have been agreed and documented for each discipline (See related documents.)These listsare notrestrictive, and laboratory staff may decide to communicate other test results attheir discretion. This may apply at weekends, where milder abnormalities may require urgentnotification if it is felt that action is required before Monday (or the first working day after apublic holiday.)

4RELATED DOCUMENTS

LP-BIO-P001_Procedure for telephoning results in Clinical Biochemistry

LI-HAE-I005_Guidelines for Haematological Results (clinical review, telephoning, blood film)

LP-MIC-P542_MICGEN: Telephoning Results

LF-BIO-F046_Handover Checklist

LF-BTS-F016_Out of Hours and On Call Handover log

5LABORATORY PROCEDURE

All laboratory results that meet critical limits criteria should be telephoned to the requesting clinician as soon as possible. Wherever possible, laboratory staff should aim to identify abnormal results andcommunicate them directly to the patient’s own GP between 08:00 and 18:30 hours onweekdays. In practical terms this is not always possible and results may need to be telephoned outside normal working hours, including bank holidays. If this is the case an out-of-hours provider who will notknow the patient nor have access to their records may need to be contacted with abnormalresults.

When it is deemed necessary to communicate an abnormal result out of hours, the laboratory staff should telephone the requesting GP. The telephone number for the GP can be found on WinPath. If outside GP opening times the call may either be automatically put through to the out-of hours provider or a recorded message will instruct the number to call.

Details of the GP telephoned and whether the call is put through to an out-of-hours provider or not should be documented by way of the WinPath “Phone results” utility. Once put through to the OOH provider the following information should be given:

the name and date of birth of the patient, together with any unique patient identifier
the abnormal test result (and reference range if requested)
the date and time of the request
the name of the requesting physician and/or the practice number
as much clinical history as is available, including relevant past results
the contact address for the patient(and telephone number if known.)

If the patient telephone number is not available on WinPath, the request form should be found in Pathology Reception. If the form does not detail the patient contact details, then the BMS should search for the patient contact details on EPR (see instructions below or refer to: LI-GEN-I008_Short guide for retrieving patient information from EPR.)

Contact details for the consultant / registrar on-call should be given to the out-of-hours service provider to enable them to seek clinical advice if required.This information is available via switchboard.

The BMS making the telephone call should ask the out-of-hours provider to repeat back all information given, including patient identification and the result, to ensure this has been correctly heard and understood.

A record of this call, including the information specified above, together with the name of the

person to whom the result was communicated and the date and time of the communication should be documented on the audit trail on WinPath.

All abnormal results telephoned to the out of hours service should also be telephonedto the requesting GP at the first opportunity within normal working hours; such results should be logged by way of departmental handover logsand day staff obliged to telephone the surgeries concerned and document having done so by means of theLIMS “Phone results” facility as before.If the out of hours service provider cannot be contacted the consultant / registrar on-call should be informed of the situation and a Datix incident report should be completed.

Following any communications with out-of-hours service providers, it is mandatory when subsequently informing the patient’s GP of any abnormal result(s,)that the GP be advised that the result was previously given to the out of hours service.The GP should also be advised that the report will be made available to them via normal reporting routes, either electronically or via paper reports.

Handover logsshould be reviewed by a senior BMS in the laboratory on a weekly basis to ensure that all abnormal results have been communicated and to monitor any issues arising.

5.1Searching for patient details on EPR

A patient’s address and telephone number can be searched for in the following way on EPR: -

Log on to “Powerchart”
From the toolbar select “Patient” and “Search”
Enter the hospital number, surname and DOB of patient and click on “Search”
Select the correct patient and click on “OK”
Close the encounter selection box
Under menu on the left of the screen select “Patient Summary.”
The patient demographics will be displayed which should include the address and telephone number (it is worth noting that the telephone number is only valid up until the point the patient last attended services at Homerton Hospital.)

5.2Reporting Issues/ Non-conformities

Any non-conformities identified when trying to telephone an abnormal GP result should be reported as an incident on Datix assigning the relevant laboratory manager or the quality manager as the handler.

Non-conformities may include:

Contact details of out-of-hours service provider not given
Unable to contact OOH service provider
OOH service provider refused to accept the results
Patient details not available to give to OOH service provider

Incidents will be reviewed on a monthly basis at the AQM and any persistent issue escalated via the Pathology Management Group.

Approved by: Y. Kelly/T. Venton/A. Hutcheon/ P. WilksReview Interval: Biennially

Author: H Hobson/ A. WyattPage 1 of 8Version: 1.1

Effective Date: June 2012

Unauthorised copies of this document are uncontrolled and therefore may be invalid

Homerton University HospitalNHS
NHS Foundation Trust / Management Procedure / MP-GEN-P054
Pathology Department / Out-of-hours reporting of laboratory results

6APPENDIX A: GP AND OUT OF HOURS SERVICE PROVIDER GUIDANCE

The importance of providing all relevant patient details, including the patient’s telephone number, when requesting pathology tests is emphasised to all Pathology users. This procedure is outlined in the Guide to Pathology Services which is available to all external Pathology users via the Trust Internet site.

The request form for Pathology requests, when an electronic form is not in use, is designed to encourage the user to complete all information required by the laboratory.

It is the responsibility of the requesting GP to complete the request form with sufficient patient details and clinical information to permit effective out-of-hours communication between the laboratory and any out-of-hours provider.

(The following guidance is taken from the RoyalCollege of Pathologists Guidance paper, written in conjunction with advisory groups and the RoyalCollege of General Practitioners)

Out-of-hours protocol for the reporting of markedly abnormallaboratory test results: advice for out-of-hours service

A markedly abnormal laboratory result may indicate that the patient needs urgent treatment. The communication of such important results should be a priority, and in certain circumstances it could be life-saving. To enable the doctor to assess the urgency of the situation, full and accurate information is crucial. This approach will save time and help with the decisions to be made. In the interest of the patient’s well being, it is the responsibility of an out-of-hours clinician to act upon abnormal results.

When contacted by the laboratory with an abnormal result in the out-of-hours period, the call

handler will obtain all the patient’s demographics and enter the information on the computer in the normal way, making sure the telephone number of the pathology laboratory is always inserted in the ‘Remarks’ box. The call handler will also take details of the pathologist and the bleep or contact details.

All the results are to be listed carefully in the ‘Symptoms’ box. Accuracy is crucial and eachrecorded result should be read back to the pathology laboratory caller for verification. The callhandler should always ask for unfamiliar words to be spelled out, and not to be afraid to ask thismore than once. When the results are to be faxed to the out-of-hours service, the call handlershould make a note of this in the ‘Remarks’ box.

If the patient’s details are incomplete, i.e. there is no contact number for the patient and no trace of a telephone number via directory enquiries, the outcome of the triage would be a home visit, with a note on the patient’s details that the patient has not been contacted.

The outcome of the triage/home visit may require the results to be passed via fax to the patient’sown GP, along with the triage/face-to-face consultation.

If the out-of-hours provider has insufficient patient contact details to carry out a visit and thehospital laboratory is unable to supply these details, it is the responsibility of the out-of-hoursprovider to ensure that the GP practices are aware of this the next working morning.

It is the responsibility of the GP commissioning body to have mechanisms in place to communicate results to the relevant GP practice or out-of-hours service. Also, for governance purposes, there must be an audit process for adverse incident reporting.

Taking action on an abnormal laboratory result

The doctor receiving the markedly abnormal laboratory test result must decide how to act in the best interests of the patient. Each case should be treated on its individual circumstances. However, it is recognised that this doctor will often have limited access to information about the patient, while the laboratory consultant will have access to the patient’s long-term laboratory record, and may also have access to further clinical information via the electronic patient record. The laboratory consultant can integrate this information with his or her specialist expertise in order to provide valuable advice to the out-of-hours doctor.

7REFERENCES

Royal college of Pathologists Guidelines: Out-of-hours reporting of laboratory resultsrequiring urgent clinical action to primary care:Advice to pathologists and those that work in laboratory medicine, November 2010 (V3)

Institute of Biomedical Science Guidelines: Giving Results over the Telephone and Facsimile, June 2011

Approved by: Y. Kelly/T. Venton/A. Hutcheon/ P. WilksReview Interval: Biennially

Author: H Hobson/ A. WyattPage 1 of 8Version: 1.1

Effective Date: June 2012

Unauthorised copies of this document are uncontrolled and therefore may be invalid