Test results that never come back: closing the loop on lab and imaging orders
A doctor orders a scan and tells the patient to come back with the result. Three things can happen next. The patient has the scan and returns. The patient never has it. Or the patient has it, the report reaches the clinic by WhatsApp or in an envelope, and nobody looks at it until the patient calls two months later to ask. In most clinics the second and third outcomes are invisible, and the third is the one that keeps doctors awake.
An order is a promise that someone will look
When a doctor orders a test, the clinic takes on a responsibility that outlasts the visit. Something was suspected, and someone has to see the answer. If the process depends on the patient bringing a paper back, the clinic has handed its responsibility to the person least able to judge whether the result matters.
A clinic can only close this gap by treating each order as an open item until a doctor has seen the result and the patient has been told. Until that point the order is unfinished work.
Four statuses, each with an owner
Every lab or imaging order should carry one of four statuses:
- Ordered: the doctor requested it. Reception owns it until the patient has the test.
- Done: the patient had the test, in-house or outside. The lab or reception owns it until the report arrives.
- Result received: the report is attached to the order. The ordering doctor owns it until reviewed.
- Reviewed: the doctor has read it, recorded a decision, and the patient has been informed.
The status belongs on the order itself, visible in the patient file and on a list. An order with no status is an order nobody is watching.
The outstanding list
Once orders have statuses, one list runs the process. Each morning reception opens every order that is not yet "reviewed", sorted by age.
- Ordered more than a week ago and not done: message the patient. Did they have the test? Do they need help booking it?
- Done more than the expected turnaround ago with no result: call the lab.
- Result received and not reviewed within two working days: the doctor is reminded, and the manager sees it after a third day.
Fifteen minutes a day on this list catches the cases that would otherwise surface as complaints. It also shows which tests patients commonly skip, and that is worth knowing. If half the patients sent for a particular scan never have it, the reason is usually cost or distance, and the doctor can raise it during the consultation.
Attach the result to the order, not only to the file
Results arrive in every form: a PDF on WhatsApp, an email from the lab, a portal login, a printed report the patient carries in. The common habit is to save the file somewhere in the patient's attachments. That stores the document and leaves the order open.
The result should be attached to the order that requested it. Then the order changes status, the doctor is notified, and anyone opening the visit sees the request and the answer together.
For values that are followed over time, such as blood sugar, kidney function or cholesterol, enter the key numbers as values as well as attaching the report. Numbers can be charted across years, and a file of PDFs cannot.
A rule for abnormal and critical results
Most results are routine and can wait for the doctor's next session. A few cannot. Agree in advance with your doctors what counts as a result that needs action the same day, and write down who does what:
- Who is allowed to recognise it: the lab flags it, or a nurse checks incoming results against the list
- Who is told, and how: a call to the ordering doctor, not a message that may be read tomorrow
- Who covers when the ordering doctor is away
- Who contacts the patient, and what is recorded
Record the time the result arrived, the time the doctor was reached and the time the patient was contacted. In the rare case that matters, that record shows the clinic acted on the result.
Tell every patient, including the normal ones
"If you do not hear from us, everything is fine" is a common rule and a dangerous one. A patient who hears nothing cannot tell whether the result was normal or was never seen.
Every result should end with a message to the patient. For normal results a short template is enough: the result has been reviewed by the doctor, no action is needed, and the next visit is on a given date. For anything that needs discussion, the message asks the patient to book, and reception follows up if they do not.
Patients notice this. A clinic that confirms normal results looks organised, and those patients come back.
Book the follow-up when the test is ordered
The simplest way to make sure a result is discussed is to book the review visit before the patient leaves, timed for after the expected result date. The order and the appointment are linked. If the result has not arrived two days before the appointment, the outstanding list shows it and reception chases the lab. The patient no longer arrives to a visit with nothing to discuss.
In-house and external tests under the same rules
A clinic with its own lab or imaging room has an advantage, because the order, the test and the result sit in one place. The statuses still apply. Measure turnaround from order to result for each test type, and tell patients a realistic time.
For external labs and imaging centres, agree how results will be delivered and to whom. One clinic email address or one portal is better than reports sent to individual doctors' phones, where they cannot be tracked and leave with the doctor.
For insured patients, check whether the test needs pre-approval before it is ordered. A patient who is sent for a scan and refused at the imaging centre's desk often does not try again.
What to measure
- Orders by status at the end of each week
- Share of orders with a result within the expected time
- Results waiting more than two working days for review, by doctor
- Orders older than 30 days that never reached "done"
The third number should be close to zero. If it is not, find the cause. It may be the workload, the notification, or a doctor who reviews on paper and never clicks.
Start this week
- List every test ordered in the last 30 days and mark which have a result on file.
- Call the patients with no result. Had it done, or not?
- Agree with your doctors what counts as a same-day result and who is called.
- Write two message templates: normal result, and please book to discuss.
- From the start of next week, book the review visit at the moment the test is ordered.
Medicolize is clinic management software for clinics and medical centres in Egypt and Saudi Arabia. Request a demo to see it on your own clinic's cases.
Questions
Who is responsible for following up a test result?
The clinic that ordered it. In practice reception tracks whether the test was done and the result arrived, and the ordering doctor is responsible for reviewing it and deciding what happens next.
What if the patient has the test done elsewhere?
Ask them to send the report, attach it to the original order and mark it received. The order stays open on the outstanding list until that happens.
Do we need to contact patients with normal results?
Yes. A short message removes doubt, and it is the only way a patient can tell a normal result from one that was never read.
How quickly should a doctor review results?
Routine results within two working days is a workable standard. Results on the clinic's same-day list are acted on the day they arrive, by the ordering doctor or the covering doctor.
Should results be sent to the patient directly?
Share them after the doctor has reviewed them, with a line on what they mean. Sending raw results with no context causes worry and extra calls.
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