The recent introduction of  the NHS Direct services as a first line contact
and triage for our local out of hours GP service, has posed a number of
problems.  We often have had to try and communicate laboratory results,
which may indicate a potentially life threatening situation, to this
service.   'You now have three choices', three choruses of Greensleaves,
'please leave a message after the tone and we will get back to you as soon
as possible', or even 'all our operatives are busy, please try again later',
as a response to your telephone call to the GP surgery is not helpful at 10
pm when you are trying to communicate a Potassium of 6.8 on a patient who
was seen several hours ago.  Until recently there was a marked reluctance to
accept responsibility for the situation from the locum service, even if we
managed to get through to them!  The recent change was brought about by the
death of a patient because the locum service was unable to respond quick
enough.

They problem has become more acute because labs are offering faster
turnaround times.  Routine requests from GP surgeries are now often analysed
through the night as part of a 7 x 24 hour lab service.  Unexpected abnormal
results are now discovered and need to be communicated to someone who is
able to respond to the clinical situation that has been identified.  This
puts a legal responsibillity on the laboratory to communicate the result, in
the past ,when the request was not analysed until the following day, the
laboratory was let off the hook, and quite often the patient died peacefully
in the night!

GP practices must recognise the problem, we are talking to our PC Trust to
find away of ensuring that when a result needs communicating there is some
one responsible to receive the result and initiate the appropriate response.
For some of the practices we service out of hours may start in the afternoon
as they close at lunch time.

Mike Guillain
Clinical Biochemist
Wansbeck General Hospital
Nothumbria Healthcare NHS Trust
Ashington
Northumberland
voice : +44(0)1670529713
fax     : +44(0)1670529719
email  : [log in to unmask]
Original Message -----
From: "Philip Hyde" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, June 28, 2000 10:50 AM
Subject: Out-of-hours results


>
> At the risk of re-visiting an old chestnut, what are the views of mailbase
> members on contacting an appropriate/responsible clinical staff member
> out-of-hours with urgent results (i.e. those exceeding the list of
critical
> limits we all have posted in the lab)in the following situations:
> 1. The closed GP Surgery.
> 2. The out-patient result where the Consultant / Med Sec have gone home.
>
> The answers would seem to be to telephone the emergency GP number or the
> Consultant via the Hospital switch-board. Do we all do this ?
> I am concerned about the medico-legal issues here and wonder if anyone has
> fallen foul of HM Crown Prosecution as a result of having been deemed to
> have failed in one's duty in this area.
> Many thanks for your input
>
> Philip Hyde,
> Pilgrim Hospital
> Boston (UK)
> ________________________________________________________________________
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>



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