Results Management - a common source of error

26 June 2019

College Medical Director, Dr Richard Medlicott recently penned his thoughts about results management, following a case published by the Health and Disability Commissioner (HDC). He has one key message: If you’re going to follow up, then follow up.

Not following up test results is a recurring pattern of incidents reported on by HDC and a recent case where a GP didn’t repeat a PSA test in six – twelve months as planned, is a prime example.

“After 12 months had gone by, the patient emailed the GP to request a PSA test – the GP said it wasn’t necessary yet and it was repeated a year later.

“By that time, the PSA had risen substantially and a diagnosis of prostate cancer was made.”

During this time, the patient was issued repeat prescriptions giving an opportunity for a note review, so the issue could have been detected sooner. 

“I don’t want to go into the pros and cons of PSA testing and intervals, but I’d like to illustrate that if there is a stated intention to follow up on a test, the simple addition of a recall or reminder would avoid all of the downstream effects of waiting for another year,” says Richard.

“The other clear learning is that if the patient makes a specific request, then it should be very carefully considered.”

Richard says safety netting in this instance would have helped to pick up that the patient’s PSA test was overdue. 

We recently heard from Dr John McMenamin about the importance of safety netting where there is a suspicion of cancer, but we can also safety net for other issues as well. 

Richard suggests using the reminder and task function in your PMS to set a prompt to follow up in a few weeks or months. 

“In this age of easy text messages and patient portals, it’s doesn’t take much time to contact the patient to ask if things have settled down.”

HDC reported: 

  • Dr B failed to meet his obligation to ensure that Mr A’s PSA levels were managed appropriately.
  • Dr B did not provide Mr A services with reasonable care and skill, and was found in breach of Right 4 (1) of the Code of Health and Disability Services Consumers’ Rights (the Code).
  • The medical centre did not have adequate processes in place to pick up that Mr A was due for a PSA test.
  • The pattern of suboptimal care provided in this case reflected a system that did not deal with repeat prescriptions adequately.
  • There was a lack of enquiry at appropriate times. The medical centre did not provide services with reasonable care and skill, and was found in breach of Right 4(1) of the Code