Non-GP initiated testing


Position

The obligation to follow up test results rests with the initiator of the test. However, it is recommended that general practitioners (GPs) who are coordinating patient-centred care should not assume that clinically significant test results ordered by others have been adequately followed up. It is good practice for a GP to seek clarification from the patient  or the initiator of the test when there is doubt as to whether clinically significant results have been followed up.

Key points

  • Responsibility for the timely follow up of test results rests with the ordering health professional, unless there has been prior agreement made with the GP.
  • However, GPs have a central role in the provision of coordinated and continuous patient-centred care. Therefore, whilst the duty to follow up test results rests with the initiator of the test, it is good practice for GPs to not assume that clinically significant test results ordered by others for their patients have been adequately followed up.
  • It is good practice for the GP to seek clarification when there is doubt as to whether clinically significant results have been followed up.
  • GPs may become aware of test results ordered by other health professionals in a number of ways, such as being copied into results, through discharge summaries, or verbally by patients. In addition, from mid 2017 it is expected that the national patient-controlled electronic health record (My Heath Record) will allow some tests initiated by other health professionals to be viewed by a patient’s GP.
  • Clear and agreed systems for receiving and following-up on test results across the healthcare sector are needed to ensure safe and effective continuity of patient care.

Background

Managing the communication of test results in general practice is an area of complexity which is known to be prone  to human error with potentially catastrophic consequences[1]. The responsibility for following up the results and determining whether appropriate action has in fact been taken, can become unclear. This is particularly the case when multiple health  care providers in the practice are involved in patient care[1]. Responsibility for following up test results can be complicated further when tests are ordered by other health professionals outside of the general practice[2].

In order to provide the most appropriate care, it is desirable for a record of all relevant medical tests performed on a patient  to be recorded in the GP’s patient health record. Other health professionals are, therefore, encouraged to inform a patient’s  GP of relevant tests performed and this should be done in a way mutually agreed between all parties.

Responsibility for the timely follow up of test results rests with the ordering health professional, unless there has been prior agreement made with the GP. However, there are situations where it may be unclear whether the follow up of results has actually occurred or with whom the responsibility for the follow up rests[2]. GPs may be sent results directly, be copied into results, or patients may advise their GP that they have had tests performed, but the results have not been received by the GP.

From mid 2017 it is expected that the national patient controlled electronic health record (My Health Record) will start automatically receiving large numbers of un-curated test results. The My Health Record may, therefore, provide an additional source of information. A GPs ability to view a patient’s My Health Record depends on whether the general practice is a participating organisation and on the patient’s access control settings.

Who should follow up?

GPs should not assume that clinically significant test results ordered by others have been appropriately followed up.  Where there is any doubt, it is good practice for GPs to take a cautious approach and check with the person who ordered  the test as to whether further follow up is recommended[2, 3]. GPs may also suggest the patient follows up with the ordering health professional.

A practice should have systems and processes in place to ensure that clinically significant test results have been dealt  with appropriately, in particular those that could immediately impact patient safety. The RACGP’s Standards for general  practice (4th edition) require a rigorous system whereby all pathology results, imaging reports, investigation reports and  clinical correspondence are followed up by the treating health professional and recorded in the GP’s patient health record.

In an increasingly electronic world, often with multiple health care professionals involved in patient care, lines of clinical responsibility can become blurred when test results are automatically sent or ‘pushed’ to GPs. Once seen, the GP may  assume some clinical responsibility to act, particularly if unsure whether the ordering clinician has acted on the results[3].

Clear and agreed systems for receiving and following-up on test results across the healthcare sector are essential,  particularly if follow-up of test results is delegated to another member of the health care team, or if a collaborative approach  to care is required.

  1. Bowie P, et al., System hazards in managing laboratory test requests and results in primary care: medical protection database analysis and conceptual model. BMJ Open 2015. 5: p. e008968.
  2. Best Practice Advocacy Centre New Zealand. Taking responsibility for test results: a discussion. Best tests 2014; 
  3. British Medical Association. Acting upon test results in an electronic world. 2016 30 June 2016; 
  4. British Medical Association. Duty of care regarding communication of investigation results. 2016 04 October 2016;

Download this position statement

Non-GP initiated testing (PDF 674 KB)