PHYSICIANS' RECIPROCAL INSURERS
Risk Management Department
Loss Prevention Technique © 1989

July - September 1989
(Volume III, Number 3)

In many cases where a failure to diagnose or a delay in diagnosis is alleged, we have found that it was not that the physician was not sufficiently aware of the patient's symptoms and the need for proper tests and consultations etc., but rather that procedural errors often lead to these difficulties. One of these areas is in the handling and follow-up of test results returned to the physician's office and in some cases, within the hospital.

The following are some guidelines on this issue:

Receipt of Reports
Most practices refer a significant number of patients and/or specimens for a wide range of diagnostic testing, on a daily basis. Usually, the physician will note in his/her medical record that the patient is to have certain tests and the medical record is returned to the file. In the event that a report is never received, the practice may not become aware of this until an inordinate length of time has elapsed.

A good method of avoiding this circumstance is to maintain a simple log of patients and specimens sent for testing. If incoming reports are checked against this log, an errant report can be identified quickly.

Review of Incoming Reports
It is preferable that all incoming reports are reviewed by the physician, however, where that is not possible, this review should be done by a physician assistant, a nurse or similarly trained personnel. It is important that the reviewer understands the significance of the data being reported.

Each report should be initialed (or signed) and dated by the reviewer, so that the review is documented and also to help mitigate against reports being filed before they are reviewed.

Telephone Reports
If preliminary reports are obtained by telephone, these results must be noted in the chart indicating that they were obtained from the laboratory verbally.

Patient Notification
Some practices leave it up to the patient to contact them regarding test results. However, especially where the results warrant treatment or other action, the physician should make contact with the patient. Of course, the information, recommendations, treatment etc. given to the patient must be documented.

Maintenance of Reports
Reports of test results should be incorporated into the patient's medical chart. Some practices choose to transcribe lab values onto their own forms; even where this is done, the original laboratory report should not be discarded.

Also, in some instances, practices will cut the reports to conform to the size of their charts. These documents should not be altered in this fashion, but should be maintained in their entirety.

Below is a list of our Loss-Prevention Techniques:

Telephone Matters | Patient Relations | Test Results and Follow-up Monitoring Patients | Patient Follow-up
Guidelines for Comprehensive Office Chart
Emergency Prepardness | Developing Telephone Protocols
Medical Office Personnel | Medication Matters
Issues in Physician Coverage
Discounting the Doctor/Patient Relationship