Tracking Biopsies and Delivering Results (Part 7 of 12)

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Whether you send biopsy samples to an external facility or use your own ancillary services, you should have a mechanism in place to track the ordering and reporting of results.

There are many ways to monitor the testing and reporting process, but it's important to choose one method and follow it religiously. Even one lost biopsy result can have serious implications for your patients' safety.

Some popular, paper-based monitoring methods are:

• Record the order — Practices sometimes schedule biopsies but fail to document the order. Or the physician tells the nurse or patient to get the biopsy but fails to document it in the patient's record. Develop a separate order form or create a template in your practice management system to document all tests ordered. You can use the sample form provided at the end of this report.
• Dictate biopsies ordered — Making a note of biopsies ordered in the patient's office note will serve as a "tickler" that staff will see when they preview charts before the patient's next appointment. The note lets them know to look for the results. However, if a patient never has a return appointment, missing results may go undetected; don't rely on this method to be fail-safe.
• Order them — Keep a copy of each biopsy order form in a date-ordered tickler file. Review this file daily to ensure that results are back when expected. Color-coding can help. For example, every biopsy ordered during the first week of the month goes into a green folder, the second week's orders that are still pending go into a yellow folder, and the third week's go into a red folder. By pulling the orders when the results come in, it makes it easy to see what is pending.
• Schedule to help — Schedule a follow-up appointment to review results five to seven days after the patient's initial appointment. Staff should preview charts for all patient visits the day before the visit to make sure the results have arrived and that anything else the physician might need for the appointment is there. That preview serves to "tickle" or remind staff that results are needed. If the patient doesn't show up for the follow-up appointment, they will be able to see that the patient still needs to be notified of the biopsy results. Some practices that we interviewed refused to deliver any results over the phone (for fear of the patient's emotional reaction). This method eliminated all of their results calls.
• Rack them — Hold patient charts with biopsies ordered and pending in a special chart rack until the results are in. Sort the charts by the date the results are expected back. Review the rack daily for charts that remain beyond the time that you expected the results to be returned. Once results are in, refile the charts quickly. Set up practice protocols: physicians will review test work within 24 hours of arrival; staff will refile the completed patient chart the same day the physician signs off. If time or geography does not permit this — that is, if you have physicians who only work a few days a week or practice in a remote location on some days — set up a policy whereby the office physician on duty reviews the test results, or a nurse summarizes the results in a brief, daily conference with the physician.
• Maintain a log of biopsies ordered — Keep the log at the nursing station, checkout counter, or referral desk. The log should include a column for "Results Back." Highlight the appropriate entries as test results are received. Scanning the log daily for past entries that are not highlighted can alert you to test results that have been delayed or lost. Make sure to keep the log private — don't post it in an area where patients passing by can review it.

Electronic tracking systems can be more reliable and comprehensive than the most advanced paper-based arrangement. Some practices have been able to electronically interface with in-house ancillaries and external providers via an EMR. They fill in the relevant fields in the patients' chart with the results and flag those charts for review.

If you don't have an EMR but want an electronic solution, try using the appointment-recall function in the scheduling module of your practice management system. Instead of recalling the patient, recall yourself. That is, key in a recall about the biopsy and route it to yourself in a week or two to make sure you have followed up on it. In other words, instead of sending a patient a postcard reminding them to make an appointment, send yourself an alert to follow up on the tests. The recall can be placed at checkout or when the biopsy is ordered.

Use the calendar function in Microsoft Outlook, or another calendar or task program, to set up automated reminders of when results are due. This requires input but at least creates a safety net; staff is proactively reminded to call for the test. The software gives them a reminder.

Or create a low-tech "to-do" list on your PDA or desktop PC. In this digital version of the manual log, you record orders and patients' names in a spreadsheet or word processing program. Mark patients' names off as results are received. Check daily for names that remain on the list after results were expected.

No matter how you make sure biopsies get done, be sure patients get the results. In too many practices, patient communication means frustrating rounds of phone tag. Instead:

• Improve scheduling — As suggested above, consider routinely scheduling patients for a follow-up appointment to review their results. They won't call in asking about results, because they know they will get them at the appointment. Plus, this is a great way to make sure results have a patient-friendly context; a provider is there to make sure the patient understands what the hard data means for them and to manage their emotional needs.
• Try automation — Communication software allows patients to call a specific number, enter an individual password, and get their results automatically. It is secure and eliminates phone tag.
• Set expectations — Let patients know when to expect results. If a patient knows results won't come back for two days, she won't be tempted to call the office every couple of hours to ask after her test, sending staff on a fruitless search for the chart.

Our essay next month will be "Human Resources."

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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.