Blood Test Results
We all receive, deal with, and file, hundreds of blood test results every week. In the vast majority of cases this is a seamless and uncomplicated process. However, over recent months a number of cases have been discussed at performance panels where the main concern has been due to incorrectly filed blood test results, or results not being actioned correctly once filed.
Incorrectly filed results
When doctors and nurses file blood results, they are usually filed as “normal” or “abnormal”, but could also be filed as “borderline”, “abnormal, but expected”, “normal, but unexpected”, or various other possibilities. There have been a number of cases in which an adverse outcome has occurred for a patient as a result of an abnormal result being incorrectly filed as “normal”. This is, of course, usually through human error. There are, however, times when an abnormal result is filed as “normal” because the clinical judgments of the clinician, such as an eGFR of 45 in a patient with known stable CKD.
When human error has occurred, and an adverse outcome as a result, such as a missed diagnosis, the performance team often look at other blood test results which have been filed by the clinician. If there are a number of times when “clinical judgment” has been used, and abnormal results are filed as “normal”, this could cause concern about the clinician’s performance.
Incorrectly actioned results
When pathology results are filed, they also usually have an action marked against them, for instance; “no action”, “make appointment”, “speak to doctor”, “repeat test” etc. If a pathology result has been filed with an action, but this action is not correctly completed, this can lead to adverse outcomes for the patient. For instance, a patient who needs further investigation for a low blood count, the result is filed as “abnormal, make appointment”, but no appointment is made. This can occur for a number of reasons, such as; the clinician has not communicated with the patient how to find the result of tests, the clinician does not ask an administrator to make the appointment, or the administrator does not make the appointment.
To reduce these risks, the LMC would recommend that;
Clinicians have time set aside for administrative tasks, such as filing blood results, so that the risk of “human error” is reduced.
If results are “abnormal”, but normal for the patient, these should be filed as “abnormal, but expected”, or “borderline”. The comments box is also a useful tool for making thought processes obvious if the results need to be reviewed later.
Practices should have robust procedures for dealing with giving patients blood test result. These procedures should be uniform between clinicians, but if clinicians vary these procedures, this should be made clear in the patient’s record, for instance “will only call the patient if the result is abnormal”.
Practices should have robust procedures for taking action on outcomes from filed blood results, so that actions are not “completed” until the action has actually been finished. This is particularly important for some results, and the procedures should highlight how particularly important results should be dealt with.