Blood tests – requesting & actioning

Practice Leads

  • Doctors: Sudhir Krishnan
  • Nurse: Melanie Greenwood

Date Reviewed

Feb 2016

Date of Next Review

September 2017

This page provides guidance for doctors, nurses and the admin team.

Requesting and arranging blood tests (DOCTOR)

  • Doctor documents during consultation in the new journal about blood test requirements
  • Doctor should inform patient about any additional requirements for the blood test – e.g. fasting, morning sample for U&Es and clotting, etc.
  • If urgent bloods are required that day, it is the doctor’s responsibility to ask admin or a nurse to arrange this
  • Doctor opens up pathology and radiology link and orders the blood tests directly from the ICE server, fills in the clinical indication and ticks the box to collect the sample later.
  • If ICE is not working, please enter the blood request in the new journal.
  • It is good practice to detail the clinical indication thoroughly

Taking the blood test (NURSE)

  • When the nurse takes the blood tests, please speak with the requesting doctor/on-call doctor if:
    • if it is not clear from the pathology request or the new journal about which bloods need taking
    • if the patient has had recent bloods that may prevent the need for repeat bloods
    • if the patient has requested additional bloods that weren’t originally requested by the GP. For example, PSA, lipids under age of 40, or any other unusual tests
  • Any routine monitoring blood tests (e.g. DMARD monitoring or annual CVD bloods) should be equally distributed among the GPs.
  • Instructions for getting results: nurse instructs or informs the patient that the results will be ready within 2 weeks and to contact the surgery in 2 weeks’ time and not earlier.

Distribution the results (ADMIN)

  • Results arrive down pathlinks, hopefully to the inbox of the requesting doctor
  • Any results arriving unallocated are forwarded to the appropriate doctor by named administrator
  • If a doctor is not working for 3 or more consecutive working days, please reallocate their results to all other GPs equally

Filing the results (DOCTOR)

  • Doctors are required to file all blood results within 5 working days (this includes the weekdays you may not work)
  • It would be good practice to at least glance at your results during every working day, because some significantly abnormal results requiring prompt action may arrive down the pathlinks
  • It would also be considered good practice to read the new journal before filing results, so that you can check the indication and clinical circumstances and relate these to the result.

Actioning the Results (DOCTOR)

When filing results you usually have 4 situations:

  1. “Normal” results requiring no action
    • File as “normal”, with “no action needed”
    • It may be useful to leave a note in the comments box for the reception/admin team to inform the patient when they ring
  2. Slightly abnormal results, or normal results where minor action is required
    • File as “abnormal”, with the appropriate action selected
    • Leave a note in the comments box, for the reception/admin team to inform the patient when they ring – e.g. your thyroid blood tests are fine, repeat again in 6 months
  3. Significantly abnormal results requiring routine action
    • File as “abnormal”, with the appropriate action selected
    • The doctor should aim to be proactive and task the “results” team to contact the patient with a message – e.g. your blood tests show that you are anaemic, please arrange a routine appointment with a doctor. No need for any concerns.
    • If the admin team are unable to contact the patient about a routine task by telephone, a standard letter will be sent by post. If this is not appropriate, the doctor should mark the task as urgent with a red flag.
    • It is good practice to write something in the new journal for good continuity of care
  4. Significantly abnormal results requiring immediate action (e.g. results phoned through by the lab)
    • File as “abnormal”, with the appropriate action selected
    • It is the doctor’s responsibility to action these results immediately
    • If you are unable to contact the patient, please speak to the admin team or the on-call doctor according to your discretion.

Contacting the patient about their results (ADMIN)

Routine tasks:

  • When admin are processing patient messages in the ‘results’ task group they should try and contact them by phone at least twice at different times.
  • If they are unable to get hold of the patient they should compose a letter by copying and pasting the doctor’s message.
  • If it doesn’t seem appropriate to include the doctor’s message, admin can send a generic letter asking the patient to contact us regarding their results.

Urgent tasks (red flag):

  • Try to contact the patient by telephone within 2 working days
  • If unable to contact the patient, please inform the GP who sent the task or the on-call GP, if the other GP is unavailable.

Other things for the Doctor to consider

  • Doctors should clear their pathology inbox before going on leave
  • If a doctor is on leave for 3 or more working days, the named administrator keeps an eye on their inbox and will redistribute any results which arrive in their absence.
  • If a doctor arranges an urgent test, it should be clearly documented in the notes and it is the requesting doctor’s responsibility to ensure that the results are acted upon e.g. D-dimer
  • In certain situations, it may be appropriate for a GP to reassign the results to the requesting GP. Please use your discretion
  • When composing messages for the tasks, please ensure that they are written in patient-friendly language - i.e. write in the way you would like the admin person to speak to the patient.  So, rather than saying "Your test is abnormal and the doctor wants to see you within the next 4 weeks" (which would panic the patient who will then demand an unnecessary on-the-day appointment), you might write 'your cholesterol test is a little high, nothing to worry about at this stage but the doctor would like to see you again in  the next 4 weeks to discuss further'.