For Healthcare Professionals Only
If your practice is like many dermatology offices, you order as many as 100 biopsies each week. That means you're also handling the 100 or so pathology reports coming back in from last week's orders, and contacting 100 or so patients each week with results. That's a lot to keep track of, and the stakes are high: a sloppy biopsy follow-up system can cause your patients unnecessary worry and frustration, and a lost or delayed result could be dangerous or even life-threatening.
There is no one right way to handle biopsy tracking and follow-up. The right procedure depends on your practice's size, patient population, and personality. The most important thing is that your process is clear and specific, with plenty of checks and balances — and that everyone in the practice follows it to the letter.
A patient-centered practice strives to see each encounter from the patient's perspective. And while the biopsy procedure may be routine to you, just hearing the word "biopsy" can make many patients anxious. Acknowledge that anxiety up-front and clearly explain the follow-up process. Let patients know when they can expect to get their results, and how you will communicate with them. As a fail-safe, tell patients to call you if they haven't heard anything by a certain date. "Make sure patients don't think that if you don't call them, everything is OK," says Scott Dinehart, MD, of Arkansas Skin Cancer Center in Little Rock.
Also, make sure patients complete and sign the HIPAA form indicating their preferences for contact. The form should indicate whether the patient gives permission for you to call her at work with results or leave information about test results on a home answering machine. Make sure this form is included in the patient's chart; you may also want to use a sticker or other identifier on the charts of patients who do not give permission for work calls or voicemail messages.
Many hands touch a biopsy specimen, so it's wise to document and track each step. Methods vary from paper-based systems to high-tech electronic interfaces between your practice and the lab. Most practices use a system that combines high-tech conveniences and the dependability of the tried and true.
No matter what your system, you need multiple checks and balances. Have separate documentation procedures for the patient's chart, with the lab, and in your practice's tracking system. The system doesn't have to be time-consuming; you can simply file one of the duplicate lab requisition forms.
What type of tracking system should you use? The old-fashioned log book is still the most popular. A few simple pieces of information and a clearly defined process are all that's needed to make a system work.
At Dinehart's practice, staff use a simple system to track as many as 100 biopsies a week: "An entry is made in the log when we send something to the pathology lab, including patient name, date, and type of biopsy," he explains. "When we receive a printed report, the entry is highlighted. When we call the patient and inform them of their results, we draw a single line through [the entry]."
The log can also help you double-check the process at other critical points. For example, at Advanced Dermatology and Skin Surgery Specialists, PA, in Naples, Fla., staff use the log book to verify the lab pick-up. "The lab courier comes twice a day," says Cyndi Yag-Howard, MD. "We compare the log book against what the courier takes on each run." Mistakes are caught quickly, and a paper trail makes them easy to correct.
You may also want to establish some type of "tickler" system for biopsy follow-up. A color-coded weekly filing system can help you track orders and tell at a glance which results are overdue (use a different-colored folder for each week of the month). Or eliminate filing and refiling of patient charts by creating a separate rack for those with outstanding biopsy orders. Organize the charts by date so you can quickly match incoming results with the patient chart.
Functions in your existing computer systems may also be used to create a paperless tickler file. Consider using the appointment recall function in your practice management system to remind you of biopsy orders that require follow-up, or use the reminder function in your calendar or task program.
From a patient-centered perspective, your post-lab procedures are the most critical part of the process. To keep things moving, establish clear protocols for each step. Be specific about how quickly the results will be reviewed by the physician and how soon the completed chart will be refiled. This keeps your system from getting bogged down, and keeps patients from waiting too long for their results. At Yag-Howard's practice, the flow is clearly defined: "The nurses review and log the report, and file it with the chart. Then the doctor signs off on the report and makes notations for treatment. Then it goes back to the nurses, who call patients with the results and explain what needs to be done for treatment."
Although patient calls are usually the nurses' responsibility, most dermatologists make calls themselves in certain cases. "If it's a patient's first time and there's a diagnosis of cancer or it's complicated, I will call," says Yag-Howard. Dinehart agrees: "I always call patients myself if it's a melanoma or a very unexpected finding or if it's difficult to explain." This small investment in time (Dinehart estimates he makes one call for every 20 his nurses make) goes a long way with patients.
Some practices rely on an automated telecommunications system to report normal results. These systems typically allow you to save prerecorded messages for patients in secure mailboxes; most also offer a call option that places an automated call to the patient and prompts him to enter a code number to access a message.
These systems offer advantages from a practice management standpoint. "You record a series of messages dealing with standard situations, with follow-up recommendations: no need for follow-up, three-month appointment, six-month appointment," says Keith Borglum, vice president at Professional Management and Marketing in Santa Rosa, Calif. "When lab results come in, you can 'drag and drop' appropriate messages into patients' mailboxes. … [Or] you can always record a custom message for any particular patient, and you can track people who don't pick up their messages."
Costs vary depending on the product, and Borglum says it's larger dermatology practices that typically use these automated telecommunications systems: "You want at least four or five dermatologists in a group to make the investment." You should also consider, however, the culture of your practice and your patient population. "I deal with an older population typically, and they wouldn't be too keen on an automated system," says Yag-Howard.
One way to avoid the calling issue altogether is to routinely schedule a follow-up appointment the day the biopsy is done. In consideration of patients' possible emotions, some practices have a policy of not delivering any results at all over the phone; even a brief appointment gives you an opportunity to answer any questions the patient may have and explain follow-up procedures face to face. Not all patients will keep follow-up appointments, though, so a mechanism must be in place for alerting staff when results still need to be delivered.
Make the time to review your practice's biopsy documentation, tracking, and follow-up procedures, and go over them again with your staff. The biopsy process is a sensitive issue for dermatology patients — and delayed or misplaced results can threaten their safety — so it warrants your special attention.
A clear, specific biopsy follow-up process — one you and your staff are able to adhere to consistently — is of paramount importance to your patients' safety and sanity. That said, you can optimize your system in any number of ways based on your practice's needs. Following are a few examples:
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Disclaimer: The material above has been prepared by Physicians Practice. It has not been reviewed by the DermQuest Editorial Board for its accuracy or reliability. Reference to any products, service, or other information does not constitute or imply endorsement, sponsorship, or recommendation by members of the Editorial Board.