East Jordan Family Health Center

Bellaire Family Health Center

Central Lake Family Health Center

TITLE: Laboratory Test Order and Result Tracking Policy

EFFECTIVE DATE: 1/01/11

DEPARTMENT:Clinical

APPROVED BY:Board of Directors

REVIEWED DATE:3/15/2012

POLICY:It is the policy of the East Jordan Family Health Center to improve patient safety and the quality of care a patient receives by ordering relevant laboratory tests and obtaining results in a timely manner.

PURPOSE:This policy ensures that ordered tests are completed and results are evaluated by the health center staff and appropriate patient follow-up occurs.

PROCEDURE:

Patient Contact Details

Patients are asked at every visit to confirm that their address, phone number and insurance is correct in the practice management system.

Performing Entities;

  1. Labs with EHR (Electronic Health Record) interface will be designated internal labs and include;

Detroit Biomedical Lab (DBML)

  1. Labs without EHR interface;

Will be designated external labs and be used when the patient’s insurance prevents use of internal labs,

Ordering Lab Tests

  1. Open the patient’s chart, create an encounter and select lab; then order.
  2. Select desired lab entityfrom the dropdown menu “Performing Entity.”
  3. Select or add a diagnosis.
  4. Click on the “Save” button at the bottom of the template.
  5. The test has been ordered and an order module will appear that shows the diagnosis and test ordered.
  6. Labs being ordered from outside labs will be printed and given to the patient.
  7. Repeat the above process if you have additional diagnoses with associated labs to order.

Reporting Normal Lab Results

  1. All lab results will automatically flow into the providers PAQ (Provider Approval Queue) for sign-off and instructions for patient notification.
  2. Providers can, at their discretion, notify patients of results or task their workgroup with instructions for patient notification, usually by letter or phone.
  3. Patients will be notified of normal lab results within 10 days.

Reporting Abnormal Lab Results

  1. All lab results will automatically flow into the providers PAQ (Provider Approval Queue) for sign-off and instructions for patient notification. Abnormal lab results will be flagged to bring them to the clinician’s attention by a color change in the description of the order. Red will indicate results are high and blue indicates results are low.
  2. Providers and/or clinical support staff will make an effort to contact all patients with clinically significant abnormal lab results within three business days of receipt.

A clinically significant abnormal lab is defined as a lab result that requires action or follow up.

  1. After three business days, if the patient cannot be contacted by phone, notification of abnormal results will be made by letter.
  2. The lab letter will include both the test results and the treatment plan from the provider.
  3. When providers will not be in the office for more than 3 days, they will indicate to the Director of Nursing which remaining provider will be reviewing and managing their PAQ during their absence.

Electronically Incorporate Results in the EHR

1)With the use of an interface, lab results will flow intostructured and searchable fields in the patient’s EHR.

Documentation of Patient Notification in the EHR

  1. When notifying a patient by phone, providers or clinical support staff will utilize the Telephone Call template for documentation.
  2. When notifying a patient in writing, the providers or clinical support staff will utilize the Document Library and select the most appropriate lab letter (Custom Lab Results Letter, Normal Labs Letter or Stable Lab Letter) for documentation.

Reporting of Internal Critical Lab Results

  1. There are 2 sets of critical lab values.
  2. Set # 1 Critical Lab Values (see attachment #1); requires immediate notification to the ordering provider or the on-call provider after business hours.
  3. Set #2 Critical Lab Values (see attachment#2); requires notification within 1 hour of receipt to the ordering provider during business hours of 8am to 6pm.
  4. Critical lab values will flow into the ordering provider’s PAQ in the EHR.
  5. To minimize the possibility of a critical lab value being overlooked in the PAQ, sent-out critical lab results will be faxed by Detroit BiomedicalLab(DBML) to the East Jordan Family Health Center(EJFHC) lab.
  6. During office hours, in-house(EFFHC)lab staff will personally deliver a hard copy of in-house or faxed critical results to the ordering or on-call Provider for review and management. They will keep a hard copy of the lab and a log of time of receipt, time of notification, and who was notified.
  7. After hours, DBML will contact the on-call physician with critical results. They will keep a log of all critical labs and note the time of receipt, time of notification, and who was notified. If problems arise with contacting the on-call physician, they will contact the EJFHC lab manager who will ensure physician notification.
  8. The Director of Operations will be responsible for providing Detroit Biomedicaland the in-house lab with a monthly provider on-call schedule and the most current contact information for providers and the EJFHC lab manager.

Reporting of External Critical Lab Results

  1. All other non-interfaced labs will also be provided with a monthly provider on-call schedule and the most current contact information for providers and the EJFHC lab manager.
  2. External labs will follow their own protocol regarding determination of critical lab values.

Lab Tracking

  1. Clinical support staff is responsible for tracking lab results on a monthly basis.
  2. On the first clinic day of each month (excluding Sat), the Director of Nursing will generate both the “Pending Sent-Out Lab Studies” and the “Pending In-House Studies” report.
  3. Each Pending lab will be reviewed;
  4. Review chart to confirm lab results are not available in the lab module or under scanned documents.
  5. The ordering Provider will be sent a “task” patient message to confirm that the ordered labs are still indicated.
  6. The support staff will contact the patient to schedule a lab visit and document this in the EHR under a completed task.

Attachment #1

Set 1 Critical Lab Values

Immediate Notification

TEST / LOW / HIGH
Calcium / 7.0 / 13.0
Hemoglobin / 8.0 / 20.0
Hematocrit / 24.0 / 60.0
INR / 5.0
Magnesium / 1.0 / 4.0
Platelets / 20.0
Potassium / 2.5 / 6.5
Sodium / 120.0
Tegretol / 15.0
Theophylline / 25.0
WBC / 1.0 / 20.0

Attachment #2

Set 2 Critical Lab Values

Notification within 1 Hour

TEST / LOW / HIGH / REVIEWED / TEST / LOW / HIGH / REVIEWED
Albumin / 2.0 / 9.0 / Phosphorus / 1.0 / 9.0
AlkPhos / 0.0 / 1000.0 / Protein T / 5.0 / 9.5
ALT/SGPT / 0.0 / 300.0 / Protime / 1.7 / 25.0
AST/SGOT / 0.0 / 300.0 / INR / 1.0 / 5.0
Amylase / 0.0 / 295.0 / PTT / 0.0 / 100.0
Bilirubin / 0.0 / 6.0 / Quinidine / 0.0 / 7.0
BUN / 0.0 / 60.0 / Tegretol / 0.0 / 15.0
Calcium / 7.0 / 13.0 / Theophylline / 0.0 / 25.0
CPK & MB / 0.0 / 585.0 / Uric Acid / 1.0 / 11.0
Digoxin / 0.0 / 3.0 / Valproic Acid / 30.0 / 110.0
Dilantin / 0.0 / 30.0 / WBC / 2.5 / 16.0
GGTP / 0.0 / 300.0 / Potassium / 3.0 / 6.0
Glucose/R / 50.0 / 500.0 / Platelet / 75.0 / 600.0
Glucose /F / 59.0 / 250.0 / Sodium / 125.0 / 150.0
Hgb / 8.0 / 20.0 / LDH / 120.0 / 1000.0
Hct / 24.0 / 60.0 / Ammonia / 0.0 / 65.0
Magnesium / 1.0 / 4.0 / Creatinine / 0.0 / 3.0
Phenobarb / 0 / 5 / Strep Culture / positive