Outside Laboratory Reports
Timothy R. Bone, President, MedMal Direct Insurance Company // January 16, 2012
The word “risk” derives from the early Italian risicare, which means “to dare.” In this sense, risk is a choice rather than a fate. This is clearly demonstrated in the dozens of cases I have 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.
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. 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; only to have the patient move across the country before that next scheduled visit. The adverse result is diagnosed years later, with increased risk of harm to the patient. A lawsuit is then 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 systems are in place that 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. And if the results are not timely received, a system must be in place that will trigger the staff to actually pursue the results.
OUTSIDE LABORATORY REPORTS
Issue: Failure of healthcare providers to determine what has been reported to their practice/clinic/hospital by outside laboratories.
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.
Review Procedure: 1. Obtain a listing of 30 patients who had laboratory tests performed outside the office/clinic/hospital (i.e., sent to another laboratory); obtain the number of the chart and, from it, the name of the physician involved. 2. Have the medical records department pull each of the charts to determine if the laboratory result has been received and has been documented in the chart. Hospitals and larger clinics may verify the findings via the laboratory’s log. 3. Contact the attending physician and/or their office to ascertain whether the physician actually learned of the results; determine how the information was transmitted.
Actions to Be Taken: 1. If all is in order, so notify the Medical Executive Committee and the medical staff at the next meeting. 2. 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.
Added Point of Emphasis: Many settlement and verdicts in excess of $1 million have resulted from this allegation of “failure to notice” abnormal laboratory results. It is well worth your time to assure you have systems in place to prevent this allegation being directed against you or your staff.
And on the other side of this equation, it is my opinion that it is equally important to advise your patient if the result is negative (i.e., normal). Your patient is nervously awaiting your contact to advise the results of the test, and it just seems to be the “best practice” to not only advise this patient of abnormal results, but also to advise of normal results as well.