Outside Laboratory Reports
How to avoid clerical errors and process slipups leading to liability issues
PULL QUOTE: “It seems to be the Best Practice to not only advise patients of abnormal results, but also to advise them of normal results.” –Timothy R. Bone, president of Florida-based MedMal Direct Insurance.
The following scenario isn’t fair, but it happens more often than you might imagine. A physician orders a test; the test results are filed in the patient’s chart with the intent of the physician reviewing the test results at the patient’s next scheduled visit. Suppose, for whatever reason, the patient doesn’t return for a follow-up visit. If the adverse result is diagnosed years later, with increased risk of harm to the patient, a lawsuit could be filed against the original healthcare provider who ordered the test, usually resulting in a large settlement.
“All of this can be avoided by simply assuring that systems are in place to guarantee the test results actually get to the healthcare provider who ordered them in the first place. Not at the next visit, not at the next grand rounds, but immediately upon receipt of the actual test results,” said Timothy R. Bone, president of Florida-based MedMal Direct Insurance. “And if the results aren’t timely received, a system must be in place that will trigger the staff to actually pursue the results.”
Noting the word “risk” is derived from the early Italian term, risicare, which means “to dare,” Bone pointed out that risk, in this sense, is a choice rather than a fate.
“This is clearly demonstrated in the dozens of cases I’ve managed over the last 38 years concerning physicians and their staff ordering laboratory tests and then failing to assure the test results are returned and are reviewed by the physician who ordered them,” he said.
If a healthcare provider orders a test, that same healthcare provider is fully responsible for ascertaining the results of that test, and for acting on those results, Bone said.
“Most of the lawsuits have arisen from the test results simply being filed in the patient’s chart, with the intent of having the physician review the test results at the next scheduled visit of the patient,” he said, “only to have the patient relocate … before that next scheduled visit.”
Failure of healthcare providers to determine what has been reported to their practice, clinic or hospital by outside laboratories is the issue concerning outside laboratory reports.
The solution: In all physician offices, clinics and hospitals, assure that any and all outside laboratory reports have been received and are carefully reviewed before filing.
Bone’s recommended review procedure:
Obtain a listing of 30 patients who had laboratory tests sent to another laboratory.
Secure the number of the chart and, from it, the name of the physician involved.
Have the medical records department pull each of the charts to determine if the laboratory result has been received and documented in the chart. Hospitals and larger clinics may verify the findings via the laboratory log.
Contact the attending physician and/or their office to ascertain whether the physician actually learned of the results.
Determine how the information was transmitted.
“If all is in order, notify the Medical Executive Committee and the medical staff at the next meeting,” said Bone. “If problems exist, devise a solution with the cooperation of the practice manager or administrator, implement it, and re-audit the issue after approximately six months. Report the results of your re-audit to the Medical Executive Committee and medical staff.”
Many settlements and verdicts in excess of $1 million have resulted from this allegation of “failure to notice” abnormal laboratory results, Bone noted.
“It’s well worth your time to assure you have systems in place to prevent this allegation from being directed against you or your staff,” he emphasized. “And on the other side of this equation, it’s my opinion that it’s equally important to advise your patient if the result is negative. Your patient is nervously awaiting your contact to advise the results of the test, and it seems to be the Best Practice to not only advise patients of abnormal results, but also to advise them of normal results.”
Editor’s Note: This article marks the ninth in a risk management series with Timothy R. Bone, president of Florida-based MedMal Direct Insurance. Florida Medical News addresses some of the most common non-clinical problems by objectively approaching each issue and its resolution via the scientific method. This process includes providing an “outcome goal” or objective, and then offering a relatively simple approach to data-gathering via chart review, observations, or simple surveys.
The series flows from the following known fact: as much as 80 percent of all medical malpractice lawsuits are generated from non-clinical issues in the practice of medicine.
Digg
Facebook
Technorati
Newsvine
Google
