Setting up your practice support systems
Your training has equipped you with an understanding of the need
for various treatments as well as the consequences of treatment
being delayed. Where treatment involves obtaining further opinion
or diagnostic tests, it is expected that the doctor will take
reasonable steps to explain the nature, purpose and urgency of the
referral or test. It is important to have efficient, reliable and
time-friendly systems to support you in these activities.
Setting your practice support systems up correctly at the outset
will enable you to track and follow up on patient outcomes. While
you may not wish to track all processes in your practice there are
some general issues to consider:
- The patient's medical condition - is it serious or
- The risks to the patient of either delaying or not receiving
the medical treatment.
- Are the test results are abnormal?
Improving your practice
In establishing an effective test-tracking system - you need to
consider which types of tests/patients should be followed up and
how. While you cannot 'force' a patient to undertake a test or
procedure, it is certainly important that you are aware of any
patients who have not had the tests you requested so you can take
any appropriate action. Once you have decided on those
tests/patients to be tracked, set up a system that allows you to
record the outgoing test centrally, not just on the patient file.
This can be done via a computer-assisted system or paper-based
- If the practice is not computerised, one way
to manage test tracking is to document all tests ordered in a manual spreadsheet recording the following
information: (sample below)
- patient's name
- test ordered
- site of biopsy (if applicable)
- histology signed by courier and date
- receipt of result including date and initials
- reviewed by doctor including date and initials
- patient notified; yes/no and date and time
- contact mode
- Once each action is completed an audit can be performed on a
patient whose actions are incomplete to determine progress of test
- Alternatively 'file isolation' can be
utilised. However, this is dependent on all patient files with
outstanding tests being kept in an 'outstanding test' section. When
the result presents, the file is removed from the isolation area;
the test result attached and provided to the doctor for review. A
regular audit can be performed on the patient files that remain in
the isolation section where no result has been performed. It is
important that if anyone removes a patient file from the isolation
area for any reason except when a test result presents, that a
large piece of paper with the patient name be replaced to ensure
the patient name remains in the isolation section.
A computer-based system can enable effective central tracking of
test results and can include the following capabilities:
- All tests can be ordered electronically, ensuring they are
automatically logged on the system.
- You, and other doctors in the practice, can action/check off
results upon receipt.
- The treating doctor can record action taken and then choose to
leave the recall facility open or closed. In this way, the test
request can remain active/open until all action necessary has been
taken (e.g. it can remain open until the patient has been back to
see you following tests).
- When the treating doctor is away, another doctor can be
nominated to check results (particularly applicable where there are
multiple practitioners in a general practice).
- It is easy to nominate a practitioner, or member of the
practice staff, to print off any outstanding test audit trail each
week for each practitioner. This allows you to identify tests
ordered where no results have been received. The practitioner will
decide which patients require follow-up.
- It is important to become familiar with the use of the
electronic patient records as this will facilitate ease of test
tracking, referral tracking and recalls.
Whether a central register is managed by a manual system or a
computerised system, the following should be done:
- A system should be in place to ensure all diagnostic tests
conducted on a patient are documented at least in the medical
- All results should be reviewed and initialled by the treating
medical practitioner, prior to filing in the patient's medical
record and an accompanying action plan documented. Computerised
patient records will record the practitioner who has reviewed the
- All clinically significant results should be followed up. The
results should be reviewed and discussed with the patient, where
appropriate, as soon as possible. A recall and reminder system
should be in place to ensure the timely notification to patients.
This could be either:
- the patient contacting the practice for their results
- and/or the practice contacting them and asking them to come
- or the routine rescheduling of patients with test results for
- If a result is significant, the medical practitioner needs to
ensure the patient is followed up, rather than relying on the
patient to contact the practice to get the result.
- Develop a policy on whether patients are required to schedule
an appointment to receive results or whether phone contact is
- Document all attempts to contact and advise patients about the
outcomes of tests or other information that could affect the state
of their health, including any significant findings. Do not wait
for the patient to act. In the event of not being able to contact a
patient with an abnormal result, staff should try to contact the
patient three times, on three different days, at three different
times of the day. All attempts at contact, whether successful or
not, should be documented in the patient file. Failing telephone
contact, a letter should be forwarded by registered mail to the
patient's address and a copy of the letter and receipt placed on
the patient's file.
- There should be a manual or computerised system to enable
regular reports of all tests performed and reconciliation with
results received, e.g. weekly.
- Patients should be advised of the practice's system of
notification of results, including the patient's responsibility to
follow up results. At booking and each consultation, patient
contact details should be checked for accuracy.
- There should be a documented patient reminder system in place,
which identifies patients needing regular follow-up, e.g. Pap
smears. Patient consent should be obtained before placing them on
the reminder system.
- Consider documenting what you tell a patient in relation to
Public Health (Cervical Cytology) Regulations (1994), Subordinate Law no.30, accessed at - www.legislation.act.gov.au
RACGP (2013), Standards for general practice (4th edition)