🧪 Abnormal Laboratory Result Workflow

To establish a standardized process for reviewing, communicating, documenting, and following up on abnormal laboratory results to ensure timely clinical intervention, patient safety, and continuity of care throughout The Neighborhood Clinic.

Purpose

Every laboratory result received by The Neighborhood Clinic must be reviewed by the ordering provider or designated covering provider. Abnormal findings require timely evaluation, appropriate patient notification, documentation, and follow-up to ensure patients receive safe, coordinated care.

Policy

No laboratory result should remain unreviewed or unresolved. Every result must receive an appropriate clinical disposition, even when no additional treatment is required.

Laboratory Result Workflow

1️⃣ Laboratory Result Received
2️⃣ Provider Reviews Result
3️⃣ Determine Result Classification
4️⃣ Document Provider Plan
5️⃣ Notify Patient
6️⃣ Complete Follow-Up

Responsibilities

Ordering Provider

  • Review all laboratory results promptly.
  • Interpret clinical significance.
  • Determine treatment plan.
  • Document recommendations.
  • Order additional testing when appropriate.
  • Determine patient follow-up requirements.

Medical Assistant

  • Monitor incoming laboratory results.
  • Route results to the appropriate provider.
  • Notify the patient of provider-approved instructions.
  • Document all communication.
  • Coordinate follow-up appointments or repeat laboratory testing.

Reception

  • Schedule follow-up appointments.
  • Verify patient contact information.
  • Assist with patient outreach when directed.
  • Document scheduling attempts.

Result Classification

All laboratory results should be categorized by the reviewing provider to determine the appropriate level of follow-up.

Normal Results

  • Within expected reference range.
  • No additional treatment required.
  • Routine patient notification when applicable.
  • Continue current plan of care.

Abnormal Results

  • Outside normal reference range.
  • Requires provider review.
  • May require medication adjustment.
  • May require repeat laboratory testing.
  • May require follow-up appointment.

Critical Results

  • Life-threatening or clinically urgent findings.
  • Immediate provider notification required.
  • Immediate patient contact required.
  • Emergency intervention may be necessary.

Critical Laboratory Results

Critical laboratory values require immediate action to protect patient safety.

Examples of Critical Findings

  • Critically high or low potassium.
  • Critically abnormal glucose levels.
  • Positive blood cultures.
  • Severely abnormal INR.
  • Critical hemoglobin values.
  • Positive life-threatening infectious disease results requiring urgent intervention.
  • Any laboratory result identified by the reporting laboratory as critical.
Critical results should never remain in an electronic message queue awaiting routine review. Staff should immediately notify the ordering provider or covering provider according to clinic policy.

Immediate Provider Notification

When a laboratory identifies a critical value, clinic staff should immediately notify the provider using the fastest available communication method.

  • Notify the ordering provider immediately.
  • If unavailable, notify the covering provider.
  • Notify clinic leadership if the provider cannot be reached.
  • Document the notification time.
  • Document the individual notified.
  • Document provider instructions.
  • Begin patient outreach immediately once provider recommendations are received.

Never Delay Critical Results

Critical laboratory results should never wait until the end of the clinic day, the next business day, or the provider's next scheduled clinic session. Immediate action is required.

Documentation Expectations

  • Date and time laboratory result received.
  • Provider review date and time.
  • Provider assessment.
  • Treatment recommendations.
  • Follow-up instructions.
  • Patient notification plan.
  • Repeat laboratory orders when indicated.
  • Scheduled follow-up appointment if required.

Documentation Standard

Documentation should clearly answer three questions:

  • What was abnormal?
  • What is the provider's plan?
  • How and when will the patient be notified?

Patient Notification Workflow

After the provider has reviewed the laboratory results and documented a treatment plan, the patient should be notified as soon as reasonably possible using the provider-approved recommendations.

1️⃣ Provider Reviews Results
2️⃣ Provider Documents Plan
3️⃣ MA Contacts Patient
4️⃣ Answer Questions Within Scope
5️⃣ Schedule Follow-Up if Needed
6️⃣ Complete Documentation

Communicating Results to Patients

Clinical staff should communicate laboratory results exactly as directed by the provider. Results should never be interpreted beyond the provider's documented recommendations.

  • Verify the patient's identity using two identifiers.
  • Review provider instructions before contacting the patient.
  • Communicate results using clear, understandable language.
  • Allow time for patient questions.
  • Refer clinical questions outside your scope back to the provider.
  • Document the communication in RXNT.
Important

Medical assistants may communicate provider-approved recommendations but should never independently interpret laboratory values or diagnose medical conditions.

Unable to Reach the Patient

If the patient cannot be reached after the initial attempt, staff should continue outreach according to clinic policy while documenting every attempt.

First Attempt

  • Call the primary telephone number.
  • Leave a HIPAA-compliant voicemail when appropriate.
  • Document the attempt.

Second Attempt

  • Attempt another telephone call.
  • Send a patient portal message when available.
  • Verify alternate contact information if appropriate.

Continued Outreach

  • Notify the provider of unsuccessful contact attempts.
  • Follow provider instructions regarding certified letters or additional outreach.
  • Continue documenting all communication efforts.

Patient Safety

Critical laboratory results should never be considered complete simply because a voicemail was left. Continue patient outreach until provider instructions have been followed or additional direction has been received.

Repeat Laboratory Testing

Some abnormal laboratory findings require repeat testing before additional treatment decisions can be made.

  • Review provider recommendations.
  • Place repeat laboratory orders as directed.
  • Schedule the patient within the recommended timeframe.
  • Provide preparation instructions when applicable.
  • Document repeat testing in RXNT.
  • Monitor completion of ordered testing.

Examples

  • Repeat Complete Blood Count (CBC)
  • Repeat Comprehensive Metabolic Panel (CMP)
  • Repeat Hemoglobin A1C
  • Repeat thyroid studies
  • Repeat lipid panel
  • Repeat urine studies

Follow-Up Appointments

Abnormal laboratory results may require additional provider evaluation depending on the clinical situation.

  • Schedule follow-up appointments according to provider recommendations.
  • Coordinate same-day appointments when clinically indicated.
  • Provide appointment details before ending the call.
  • Document appointment scheduling.
  • Notify the provider if the patient declines recommended follow-up.

Critical Result Documentation

Every critical laboratory value should include complete documentation of the provider notification and patient communication process.

  • Laboratory reporting time.
  • Critical value received.
  • Time provider notified.
  • Name of provider notified.
  • Provider instructions.
  • Time patient contacted.
  • Patient response.
  • Recommended disposition.
  • Emergency Department referral when applicable.
  • Follow-up completion.

Never Close a Critical Result Until Resolved

Critical laboratory values remain active until the provider's recommendations have been communicated and appropriate follow-up has been completed or documented.

Quality Assurance

Medical Assistant

  • Review pending laboratory messages daily.
  • Monitor outstanding patient callbacks.
  • Follow provider instructions promptly.
  • Complete documentation.

Provider

  • Review incoming laboratory results promptly.
  • Document treatment plans.
  • Address critical values immediately.
  • Ensure appropriate follow-up.

Leadership

  • Audit unresolved laboratory results.
  • Review delayed patient notifications.
  • Monitor quality metrics.
  • Provide workflow education when needed.

Abnormal Laboratory Result Checklist

✅ Provider reviewed laboratory result
✅ Result classified appropriately
✅ Provider documented treatment plan
✅ Patient notified
✅ Questions addressed within staff scope
✅ Follow-up appointment scheduled when indicated
✅ Repeat laboratory testing ordered when required
✅ Critical results escalated immediately
✅ All outreach attempts documented
✅ RXNT documentation completed
✅ Workflow resolved and closed

Sawubona Standard

Abnormal laboratory results are more than numbers—they represent patients relying on us for timely answers and safe medical care. Every result should be reviewed promptly, communicated compassionately, documented thoroughly, and followed through to completion. At The Neighborhood Clinic, no abnormal result is complete until the patient understands the next step in their care.