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Cole's Guidelines on the Management of Clinical Investigations

coles book cover

Southern Community Laboratories strongly endorses Chapter 14 of Cole's Medical Practice in New Zealand (2013) as a framework for the follow-up of patient test results. We expect all our referrers to understand and observe the eight key principles listed:

  1. If you request a clinical investigation, you should tell your patient why the clinical investigation is recommended and when and how they will learn the results
  2. All the relevant parties should understand their responsibilities clearly
  3. If you are responsible for conducting a clinical investigation you are also responsible for ensuring that the results are appropriately communicated to those in charge of conducting follow up, and for keeping the patient informed
  4. If you are responsible for informing the patient, you should:
    • Inform the patient of the system for learning test and procedure results, and arranging follow up
    • Ensure that staff and colleagues are aware of this system
    • Inform patients if your standard practice is not to notify normal results and obtain their consent to not notifying
    • If other arrangements have not been made, inform the patient when results are received. This is especially important if the results raise a clinical concern and need follow up.
  5. Identifying and following up overdue results is an essential, but [sometimes] difficult, office management task. Your system should ensure that test results are tracked successfully. Such a system might be a paper file or computer database that identifies:
    • High risk patients
    • Critical clinical investigations ordered
    • Dates of reports expected
    • Date of expected or booked follow up patient visit
  6. The patient’s medical chart itself might be flagged in some way to aid this tracking
  7. It can sometimes be difficult to contact a patient by telephone, and sometimes they do not attend planned follow up appointments:
    • The number and intensity of efforts to reach the patient by telephone should be proportional to the severity and urgency of the medical problem. All attempts to contact the patient should be documented.
    • If the patient fails to attend an appointment, or you have been unable to speak to them directly about test results which raise a clinical concern, then send a letter to the patient advising them of the action they should take
  8. If you order investigations it is your responsibility to review, interpret and act on the results. If you go off duty before the results are known, you should alert the incoming doctor that there are results outstanding. Furthermore, you should check the results when you are next on duty.

 

Cole's entire text is available for free download from the Medical Council of New Zealand (including Kindle and iPad versions).

We ask all our referrers to familiarise themselves with the guidelines in Chapter 14. We also strongly recommend a review of the very useful discussion article Taking responsibility for test results from Best Tests, August 2014.