Homerton University Hospital NHS
Management Procedure / MP-GEN-P054
NHS Foundation Trust
Pathology Department
Out-of-hours reporting of laboratory
results
Out-of Hours reporting of laboratory
results
Pathology Department
Homerton University Hospital
NHS Foundation Trust
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Approved by: Y. Kelly/T. Venton/A. Hutcheon/ P. Wilks
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Author: H Hobson/ A. Wyatt
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Homerton University Hospital NHS
Management Procedure / MP-GEN-P054
NHS Foundation Trust
Pathology Department
Out-of-hours reporting of laboratory
results
TABLE OF CONTENTS
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1
PURPOSE / CLINICAL RELEVANCE ..................................................................... 3
2
RESPONSIBILITIES ................................................................................................ 3
3
DEFINITIONS .......................................................................................................... 4
4
RELATED DOCUMENTS ........................................................................................ 4
5
LABORATORY PROCEDURE ................................................................................ 4
6
APPENDIX A: GP AND OUT OF HOURS SERVICE PROVIDER GUIDANCE ........ 7
7
REFERENCES ......................................................................................................... 8
Approved by: Y. Kelly/T. Venton/A. Hutcheon/ P. Wilks
Review Interval: Biennially
Author: H Hobson/ A. Wyatt
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Homerton University Hospital NHS
Management Procedure / MP-GEN-P054
NHS Foundation Trust
Pathology Department
1
Out-of-hours reporting of laboratory
results
PURPOSE / CLINICAL RELEVANCE
Following the reporting of several serious untoward incidents relating to the inability of laboratory
staff to find an appropriate primary care physician to act on a life-threatening or markedly
abnormal test results, the Royal College of Pathologists has produced guidelines for laboratories
to follow when reporting critical results to GP’s outside of normal hours. Local incidents where
the GP out-of-hours service provider for Homerton University Hospital will not accept results
have also been recorded.
Research quoted by the Royal College of Pathologists identifies that the problems in reporting
and acting on markedly abnormal laboratory test results fall into three main areas:
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laboratory staff not knowing whom to contact when a GP surgery is closed and not
knowing how to make that contact
staff at the out-of-hours provider not appreciating the importance of the abnormal result
and being unwilling to accept responsibility for the result
staff at the out-of-hours provider being unable to contact the patient and/or unable to
access patient records as part of the corrective action.
The out-of-hours provider will usually have no previous knowledge of the patient and limited
access to patient records. The abnormalities being communicated are, by their very nature,
acute and potentially life-threatening. Laboratory staff play a key role in interpreting the results in
the context of other information available in the laboratory, and in guiding the out-of-hours doctor
receiving the result.
2
RESPONSIBILITIES
It is the responsibility of pathology services to work with out-of-hours providers and Primary Care
Trusts (PCTs) / GPs to ensure that adequate local arrangements are in place to deal with the
reporting of abnormal test results out of hours. It is normally outside the remit of the professional
role of clinical laboratory staff to contact patients directly with abnormal results.
The responsibility of the laboratory staff is to communicate any markedly abnormal test result to
the clinical team – either to the GP who made the request or to the out-of-hours provider. It is the
responsibility of the requesting clinical team to review results of tests that they have requested
and have proper handover arrangements in place to review and act on abnormal results after
hours, in the best interests of the patient.
The PCT or commissioning body has a responsibility to ensure that adequate out-of-hours cover
arrangements are available, and that details of these arrangements are communicated to the
laboratory.
Approved by: Y. Kelly/T. Venton/A. Hutcheon/ P. Wilks
Review Interval: Biennially
Author: H Hobson/ A. Wyatt
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Homerton University Hospital NHS
Management Procedure / MP-GEN-P054
NHS Foundation Trust
Pathology Department
3
Out-of-hours reporting of laboratory
results
DEFINITIONS
“Out of hours” refers to the period of the working week when GP surgeries are unstaffed (often
18:30–08:00 hours every weekday and all day at weekends and bank holidays, though some
surgeries and walk-in centres/urgent care centres are now open 08:00–20:00, either weekdays
or every day) and/or responsibility for patient care has been passed from the normal GP to an
out-of-hours provider.
A markedly abnormal laboratory test result is a result that may signify a pathophysiological state
that may be life-threatening or of immediate clinical significance and that requires urgent action.
A list of such markedly abnormal laboratory test results have been agreed and documented for
each discipline (See related documents.) These lists are not restrictive, and laboratory staff may
decide to communicate other test results at their discretion. This may apply at weekends, where
milder abnormalities may require urgent notification if it is felt that action is required before
Monday (or the first working day after a public holiday.)
4
RELATED DOCUMENTS
LP-BIO-P001_Procedure for telephoning results in Clinical Biochemistry
LI-HAE-I005_Guidelines for Haematological Results (clinical review, telephoning, blood film)
LP-MIC-P542_MICGEN: Telephoning Results
LF-BIO-F046_Handover Checklist
LF-BTS-F016_Out of Hours and On Call Handover log
5
LABORATORY PROCEDURE
All laboratory results that meet critical limits criteria should be telephoned to the requesting
clinician as soon as possible. Wherever possible, laboratory staff should aim to identify abnormal
results and communicate them directly to the patient’s own GP between 08:00 and 18:30 hours
on weekdays. In practical terms this is not always possible and results may need to be
telephoned outside normal working hours, including bank holidays. If this is the case an out-ofhours provider who will not know the patient nor have access to their records may need to be
contacted with abnormal results.
When it is deemed necessary to communicate an abnormal result out of hours, the laboratory
staff should telephone the requesting GP. The telephone number for the GP can be found on
WinPath. If outside GP opening times the call may either be automatically put through to the outof hours provider or a recorded message will instruct the number to call.
Details of the GP telephoned and whether the call is put through to an out-of-hours provider or
not should be documented by way of the WinPath “Phone results” utility. Once put through to the
OOH provider the following information should be given:

the name and date of birth of the patient, together with any unique patient identifier
Approved by: Y. Kelly/T. Venton/A. Hutcheon/ P. Wilks
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Homerton University Hospital NHS
Management Procedure / MP-GEN-P054
NHS Foundation Trust
Pathology Department
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Out-of-hours reporting of laboratory
results
the abnormal test result (and reference range if requested)
the date and time of the request
the name of the requesting physician and/or the practice number
as much clinical history as is available, including relevant past results
the contact address for the patient (and telephone number if known.)
If the patient telephone number is not available on WinPath, the request form should be found in
Pathology Reception. If the form does not detail the patient contact details, then the BMS
should search for the patient contact details on EPR (see instructions below or refer to: LI-GENI008_Short guide for retrieving patient information from EPR.)
Contact details for the consultant / registrar on-call should be given to the out-of-hours service
provider to enable them to seek clinical advice if required. This information is available via
switchboard.
The BMS making the telephone call should ask the out-of-hours provider to repeat back all
information given, including patient identification and the result, to ensure this has been correctly
heard and understood.
A record of this call, including the information specified above, together with the name of the
person to whom the result was communicated and the date and time of the communication
should be documented on the audit trail on WinPath.
All abnormal results telephoned to the out of hours service should also be telephoned to the
requesting GP at the first opportunity within normal working hours; such results should be logged
by way of departmental handover logs and day staff obliged to telephone the surgeries
concerned and document having done so by means of the LIMS “Phone results” facility as
before. If the out of hours service provider cannot be contacted the consultant / registrar on-call
should be informed of the situation and a Datix incident report should be completed.
Following any communications with out-of-hours service providers, it is mandatory when
subsequently informing the patient’s GP of any abnormal result(s,) that the GP be advised that
the result was previously given to the out of hours service. The GP should also be advised that
the report will be made available to them via normal reporting routes, either electronically or via
paper reports.
Handover logs should be reviewed by a senior BMS in the laboratory on a weekly basis to
ensure that all abnormal results have been communicated and to monitor any issues arising.
5.1
Searching for patient details on EPR
A patient’s address and telephone number can be searched for in the following way on EPR: 1. Log on to “Powerchart”
2. From the toolbar select “Patient” and “Search”
3. Enter the hospital number, surname and DOB of patient and click on “Search”
Approved by: Y. Kelly/T. Venton/A. Hutcheon/ P. Wilks
Review Interval: Biennially
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Homerton University Hospital NHS
Management Procedure / MP-GEN-P054
NHS Foundation Trust
Pathology Department
4.
5.
6.
7.
5.2
Out-of-hours reporting of laboratory
results
Select the correct patient and click on “OK”
Close the encounter selection box
Under menu on the left of the screen select “Patient Summary.”
The patient demographics will be displayed which should include the address and
telephone number (it is worth noting that the telephone number is only valid up until the
point the patient last attended services at Homerton Hospital.)
Reporting Issues/ Non-conformities
Any non-conformities identified when trying to telephone an abnormal GP result should be
reported as an incident on Datix assigning the relevant laboratory manager or the quality
manager as the handler.
Non-conformities may include:
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
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Contact details of out-of-hours service provider not given
Unable to contact OOH service provider
OOH service provider refused to accept the results
Patient details not available to give to OOH service provider
Incidents will be reviewed on a monthly basis at the AQM and any persistent issue escalated via
the Pathology Management Group.
Approved by: Y. Kelly/T. Venton/A. Hutcheon/ P. Wilks
Review Interval: Biennially
Author: H Hobson/ A. Wyatt
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Homerton University Hospital NHS
Management Procedure / MP-GEN-P054
NHS Foundation Trust
Pathology Department
6
Out-of-hours reporting of laboratory
results
APPENDIX A: GP AND OUT OF HOURS SERVICE PROVIDER GUIDANCE
The importance of providing all relevant patient details, including the patient’s telephone
number, when requesting pathology tests is emphasised to all Pathology users. This procedure
is outlined in the Guide to Pathology Services which is available to all external Pathology users
via the Trust Internet site.
The request form for Pathology requests, when an electronic form is not in use, is designed to
encourage the user to complete all information required by the laboratory.
It is the responsibility of the requesting GP to complete the request form with sufficient patient
details and clinical information to permit effective out-of-hours communication between the
laboratory and any out-of-hours provider.
(The following guidance is taken from the Royal College of Pathologists Guidance paper, written
in conjunction with advisory groups and the Royal College of General Practitioners)
Out-of-hours protocol for the reporting of markedly abnormal laboratory test
results: advice for out-of-hours service
A markedly abnormal laboratory result may indicate that the patient needs urgent treatment. The
communication of such important results should be a priority, and in certain circumstances it
could be life-saving. To enable the doctor to assess the urgency of the situation, full and
accurate information is crucial. This approach will save time and help with the decisions to be
made. In the interest of the patient’s well being, it is the responsibility of an out-of-hours clinician
to act upon abnormal results.
When contacted by the laboratory with an abnormal result in the out-of-hours period, the call
handler will obtain all the patient’s demographics and enter the information on the computer in
the normal way, making sure the telephone number of the pathology laboratory is always
inserted in the ‘Remarks’ box. The call handler will also take details of the pathologist and the
bleep or contact details.
All the results are to be listed carefully in the ‘Symptoms’ box. Accuracy is crucial and each
recorded result should be read back to the pathology laboratory caller for verification. The call
handler should always ask for unfamiliar words to be spelled out, and not to be afraid to ask this
more than once. When the results are to be faxed to the out-of-hours service, the call handler
should make a note of this in the ‘Remarks’ box.
If the patient’s details are incomplete, i.e. there is no contact number for the patient and no trace
of a telephone number via directory enquiries, the outcome of the triage would be a home visit,
with a note on the patient’s details that the patient has not been contacted.
The outcome of the triage/home visit may require the results to be passed via fax to the patient’s
own GP, along with the triage/face-to-face consultation.
Approved by: Y. Kelly/T. Venton/A. Hutcheon/ P. Wilks
Review Interval: Biennially
Author: H Hobson/ A. Wyatt
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Homerton University Hospital NHS
Management Procedure / MP-GEN-P054
NHS Foundation Trust
Pathology Department
Out-of-hours reporting of laboratory
results
If the out-of-hours provider has insufficient patient contact details to carry out a visit and the
hospital laboratory is unable to supply these details, it is the responsibility of the out-of-hours
provider to ensure that the GP practices are aware of this the next working morning.
It is the responsibility of the GP commissioning body to have mechanisms in place to
communicate results to the relevant GP practice or out-of-hours service. Also, for governance
purposes, there must be an audit process for adverse incident reporting.
Taking action on an abnormal laboratory result
The doctor receiving the markedly abnormal laboratory test result must decide how to act in the
best interests of the patient. Each case should be treated on its individual circumstances.
However, it is recognised that this doctor will often have limited access to information about the
patient, while the laboratory consultant will have access to the patient’s long-term laboratory
record, and may also have access to further clinical information via the electronic patient record.
The laboratory consultant can integrate this information with his or her specialist expertise in
order to provide valuable advice to the out-of-hours doctor.
7
REFERENCES
 Royal college of Pathologists Guidelines: Out-of-hours reporting of laboratory results
requiring urgent clinical action to primary care: Advice to pathologists and those that work
in laboratory medicine, November 2010 (V3)
 Institute of Biomedical Science Guidelines: Giving Results over the Telephone and
Facsimile, June 2011
Approved by: Y. Kelly/T. Venton/A. Hutcheon/ P. Wilks
Review Interval: Biennially
Author: H Hobson/ A. Wyatt
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