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A patient presented to a private hospital emergency department following an injury. She underwent an x-ray and computed tomography (CT) and was discharged a few hours later with a diagnosis of shoulder soft tissue injury with follow-up by a local orthopaedic surgeon for review.
The formal CT report, finalised two days later, showed a soft tissue mass in the patient’s neck and recommended ear nose throat (ENT) review and follow up MRI. The reporting radiologist noted in his report that this was discussed with the doctor who had seen the patient in the emergency department. A copy of the final radiology report was sent to the emergency department and filed in the patient’s hospital file – which would not have been immediately available to the orthopaedic surgeon who was responsible for the patient’s follow up.
The patient presented to the orthopaedic surgeon a few days later as recommended by the emergency department. From the notes it is clear that the orthopaedic surgeon reviewed the available x-rays but did not read the radiologist’s report. The patient presented to the same emergency department two years later for an unrelated matter and was informed of her CT neck result for the first time.
The patient advised her GP and this was the first time action was taken for her neck mass. The patient was subsequently diagnosed with metastatic squamous cell carcinoma and complained to the HPCSA about both the emergency department doctor and the orthopaedic surgeon.
Medical Protection assisted our members with their respective responses to the HPCSA. We helped the emergency department doctor convey that he had no recollection of the phone call from the radiologist (which was contemporaneously mentioned in the radiologist’s report) as he would have taken care to act on this.
On reviewing the orthopaedic surgeon’s notes it was clear that she had reviewed the relevant radiology results but not reviewed the radiologist’s opinion as this was unnecessary for her to confirm the injury that the patient was referred for.
Additionally no paper copy of the final radiology report was available to her.
While the orthopaedic surgeon’s explanation was accepted, the emergency doctor did not escape criticism. It is likely that the claim that followed this incident will have to be settled.
Which of the following statements is more likely to be true?
The failure to follow up test results, particularly in shared care, is rare.
The failure to follow up test results, particularly in shared care, is not rare.
Which of the following statements is best practice?
In shared care the follow up of test results ordered by the clinician who requested them remains that clinician’s sole responsibility.
In shared care the follow up of test results ordered by the initial clinician who requested them becomes the sole responsibility of the clinician who subsequently cares for the patient.
In shared care the follow up of test results ordered is the shared responsibility of the treating clinicians and is best resolved by good communication.
No follow-up is needed if the test result is normal
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