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The Royal College guideline does suggest discussing critical results with the o/c person with the medic. Just that we have a meeting set up to discuss this issue. I feel that system needs to be in place for the o/c person to look at historical data and clinical data and with it the contact details for the medic. With our system all this is not possible and will cause delay in phoning the result.



Mike's lab of having a biochemist till 9pm may be the answer to majority of GPs critical results? This may not be feasible in all labs though.

Richard has an excel sheet but don't know this will communicate with our IT system.



Many thanks for your replies.

Bharat



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We now have a biochemist in the lab until 9pm weekdays (one day a week, someone works 1-9pm), so they have access to past results and forms. We find that covers all the GP/OP work - it is rare to have a critical result generated after 9pm.



Very often, "OPD" results will have been taken in primary care anyway.

We haven't encountered the specific problem of the deputising service refusing to take results, though we would ensure it really was a critical result requiring immediate admission - anything else would be phoned to the hospital requesting team first thing in the morning.



Our hospital offers a clinical chemistry fellowship. Therefore, either path residents or mainly clinical chemistry fellows will be on call 24/7. Everyone, the medical team and the laboratory stuff can call them with any kinds of questions. Nevertheless, we have a a policy in place that says if send-outs exceed a certain price or maybe 20-30 different lab values exceed a certain threshold the fellows have to be paged for further follow up. Then, the fellow is investigating the case and contacting the medical team to discuss this lab value or unusual case.



We have an SOP tat is based on the guidance given by the College (http://www.rcpath.org/NR/rdonlyres/29955224-DDCA-461E-BD7B-9A69A7DB21AB

/0/g025_outofhoursreporting_nov10.pdf)



The BMS staff will contact the clinical biochemist or chemical pathologist on-call and then we will contact the out of hours GP Service. We give the results to them if the patient has been seen by their GP. This generally works well and patients are often admitted to hospital by the OOH service if warranted.



With results from patients seen in OPD we try to contact someone from the team on call in the hospital but often we have to fall back on the OOH GP service who normally respond positively. There are not many of these, in fact it must be more than a year since I have had such a scenario.



Follow RCPath guidelines for levels with a couple of exceptions. Phone creatinines above 250umol/l (rather than 500 at request of Renal Consultant as part of trust’s response to AKI report) and calcium above 3.00 mmol/l (rather than 3.5) as response to clinical incident a few years back.



The calls are made by the BMS (little point in going via senior staff on call, it just slows the process) to the out of hours deputising service. After initial problems a few years back they now accept that they the patients GP out of hours and have responsibility for all of his patients. Not just those that contact the out OOH service. We fax results to service.and are prepared to release patient address if necessary.



The other problem of OPD with results occurring when nobody is there is more problematic. We have agreement with the adult medicine that their registrar must accept the results and deal with it (all he needs to do is tell the patient to go to A&E). Registrars often resist this hence the need to re-establish the principle every so often. This is often where the senior staff on call needs to get involved. Generally it usually works.



Whilst on call I rarely call a medic to discuss results.  If they are GP results that the lab has called me about then usually I add a comment and the BMS will call it through to the out of hrs service or GP practice if they are still open.  I have discussed results directly with hospital doctors, mostly because they have rung me, but sometimes there is the odd situation when it is best/easier to talk to them directly, usually the BMS calls and a comment, when needed is added, and then the BMS will transmit this on to the relevant person



I have developed an excel spreadsheet to handle this.

Don't know if it will work on your system.

The first is a magic interactive version which can be accessed live with appropriate actions.

The second workbook is a selection of sheets with the raw data for display in paper format and forms the basis of the magic one, but is a bit clunky.


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