Blood Test Protocol

Introduction

1.1 – Policy Statement

To provide a standardized approach for requesting, reviewing, and actioning test results, ensuring timely and effective communication with patients while maintaining confidentiality and accuracy.

1.2 – Scope

This protocol applies to:

All clinical staff, including GPs, nurses, and healthcare assistants.
Administrative staff managing test bookings and results communication.
Tests such as blood work, imaging (x-rays, scans), and other diagnostic procedures.

Whenever a doctor orders a test, Patient will be referred to the Phlebotomy services as practice does not provide this service.

Phlebotomy service should advice patient to contact practice in reasonable time depending on test carried out, most blood, urine and faecal (poo) tests are usually back within 2 weeks. Other tests can take longer. So, if the patient has had several blood tests done, please advice them to call back in 2 weeks time when the result will be actioned by a clinician.

Clearly, you don’t obey the 2 week rule if the blood test is marked urgent – like a D-dimer – in which case they are usually back after 48 hours (2 days). The results usually come back to us electronically down what we call Pathlinks. Often, it will go to a specific doctors inbox – but the reception staff can log in and allocate it to a different doctor (for example – when the doctor is on annual leave, or to distribute the results more evenly across all the docs).

1.3 – Responsibilities

General Practitioners (GPs):

Review and interpret results.
Make clinical decisions based on findings.
Ensure appropriate follow-up and documentation.

Nurses/Healthcare Assistants: (patients are referred to phlebotomy clinic)

Conduct initial tests (e.g., phlebotomy).
Support patient preparation and guidance.

Administrative Staff:

Ensure test requests are processed correctly.
Monitor incoming results and flag unfiled results.

Procedure (Doctors)

2.1 – When Requesting a Blood Test

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 etc.
If urgent bloods are required that day, it is the doctor’s responsibility to direct the patient to the phlebotomy services.
Doctor opens up pathology and radiology link (TQuest) 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 TQuest is not working, please enter the blood request in the new journal. Patients can not amend the request form, if they do it will be rejected.
It is good practice to detail the clinical indication thoroughly.
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 up on e.g. D-dimer

2.2 – Filing Blood Results

Results are looked by GP Automate (AI). Normal results will be filled in patients notes and a message will be sent to patient.
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.
In certain situations, it may be appropriate for a GP to reassign the results to the requesting GP. Please use your discretion

2.3 – Actioning Blood Results

Abnormal results will be reported on by the doctor using the EMIS Web tasks system.

If a test result is normal and requires no further action, it will be ‘filed’ as “no action required”. Admin staff will be able to see the ‘normal’ result filed within the patient’s record should they ring up and enquire. GP Automate action all the normal results and send a message to patients.

Some results will be abnormal and require specific action. For these sorts of results, the doctor will send an ‘action task’ to the ‘Admin’ group within EMIS Web before filing the result. The action might be…

To make an appointment with Doctor
To make an appointment with Nurse
Re-refer to new test/different test or repeat test etc.

The admin member of staff will then contact the patient to implement this requested action. This process means that the practice takes pro-active action in contacting all patients who have ended up with an abnormal result, whilst implementing the requested doctor’s actions without the need for all patients to see the doctor again (and hence use up valuable doctor consultation time).

When filing results you usually have 4 situations:

“Normal” Results requiring no action
- File as “normal”, with “no action needed”. Message is sent to the patient by GP Automate (AI)
- Just be careful with normal HBA1Cs in Diabetics who are on insulin – they could be having hypos – go into records and see if they need a review.
Slightly abnormal results that you are not worried about (eg slightly low eGFR but stable for years)
- File as “satisfactory”, with “no action needed”
- Leave a note in the comments box, if you feel it would be helpful – e.g. “your thyroid blood tests are fine, repeat again in 6 months”, “you’re kidneys arent working as well as when you were younger. But this is normal and your kidney tests show yours is stable and nothing to worry about.”
Slightly or Significantly abnormal results requiring routine action
- File as “abnormal”, with the appropriate action selected
- The doctor should aim to be proactive; task the “results” team to contact the patient with a message – e.g. “your blood tests show that your liver tests have slightly gone off. Nothing to worry about at this stage but it is important to get a repeat liver test in 2 weeks time”
- Make sure you include a time frame with any suggested action eg within 2 weeks, within 4 weeks, do not write “2-4 weeks – that is confusing – 2 weeks or 4 weeks? – how can a patient decide?
- 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
Slightly or Significantly abnormal results requiring urgent 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 – you may need to call the patient directly yourself eg an anaemia of 6.5
- If you are unable to contact the patient, please speak to the admin team or the on-call doctor according to your discretion.
- Of course, you can task the “RESULTS” team and “red flag” the item – admin team always work on the red flag messages in their inbox before working on the routine. For example, red flag the following message “You’re blood tests shows that you have become anaemic. Please come and see the doctor within 1 week to assess you. This is important.”

Procedure (Admin)

3.1 – 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.

3.2 Urgent Tasks (Red Flag)

Remember – red flag tasks are urgent things – work on these before any of the others.
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.

3.3 – If patients contacts you regarding test

If the result are not back

Determine whether it has been 2 weeks since the test was done.
If it less than 2 weeks, explain to the patient that results usually take 2 weeks to come back and therefore to ring again after this time.
If it has been more than 2 weeks, explain to the patient that the result is not back from the labs. Apologise for the delay and that you will personally chase this up and get back to them within 24-48 hours. Ring the lab and chase the result. Once you’ve managed to get the result back, show it to a doctor (preferably the requesting doctor or the on-call doc) to get a professional interpretation of the result and what to say to the patient. Then, ring the patient back.
Do not put any of these down for a telephone consultation/call with the requesting doctor nor the emergency on call doctor. Sort the problem out yourself first.

If the result are back AND has been reported on by a doctor

Give the test result – try and use the words the doctor has written.
If the interpretation is not clear – ask that doctor for clearer advice (rather than risk giving the patient the wrong information)
Ask the patient if there were any other tests that were done

If the result are back BUT has not been reported on

If it is less than 1 week since the test was back, advise the patient that the test is back but that the doctor will be shortly going through them. Advise them to ring again in 1 week and explain that this should give the doctor some time to report back on them.
If it is more than 2 weeks since the test was done, apologise for the result not being reported on. Tell them that you will personally chase it up and get a doctor to take a look within 24h and get back to them.
Get in touch with the doctor who is meant to have reported on the result – ask them for an interpretation. You can send a EMIS Web Task to do this, although it is probably much easier and quicker to ask the doctor in person when they are at their computer screen.
Get the doctor to comment and ‘file’ the report within EMIS.
Then call the patient back and explain the result.