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Hello.
I am looking for advice or suggestions for handling the following situation: 
A community patient presents for collection of blood specimens and provides two requisition forms (one from a family physician and one from a specialist).   The two requisition forms have some tests in common (perhaps electryolytes or an INR, etc) and some different tests. How does your lab handle this situation? 
[A] If your lab tries to avoid duplicate testing (by pooling one of each test on a single order, and reporting one large set of results to BOTH physicians), then two problems arise: 
Some physicians complain that the lab is attributing test orders to them inappropriately.  It is not clear which ordering physician is responsible for the orders (and responsible for patient management when critical test results are called). Not to mention: It might appear that both phycians could be phoned when a critical result occurs. 
[B] If the lab treats each requisition as a separate order:  Duplicate orders will bring about duplicate specimen collections, testing and reporting.  Some lab databases (electronic records) will shown both test results and the results are often not identical.  In this manner, the imprecision of lab tests is well depicted.  There will be frequent phone calls about discrepancy of lab results for specimens collected at the same time. "which potassium is correct, 6.1 mmol/L or 6.4 mmol/L"...and you could reply "both" (and both physicians would be called to take responsibility for dealing with this critical event).  Some electronic software rules may automatically cancel the duplicate tests (more often seen in hospital patient situations). 
[C] Perhaps another process that you would share?  We are looking for innovative solutions.  
When a patient presents with two requisitions, we are considering the feasibility of creating three orders:  Unique orders for the family doc, unique orders for the specialist and a separate lab 'order' for the joint-tests (that will be designated as specialist-orders by the lab service and copied to the family doc).  In this manner, only the staff entering the orders in the lab computer need to change the handling process. Tests are only performed once. The physician responsible for orders is clear and only a single version of each test appears in the lab database (for this phlebotomy event). 
I look forward to hearing suggestions, thank-you, regards, Andrew
Dr. Andrew Lyon
Saskatoon Health Region, SK, Canada.

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