Keeping Tabs On High-Risk Patients

Patient tracking and recall are integrated systems that help keep high-risk patients close to the practice.  The systems also remind staff when a patient appears to not be getting recommended care.  The staff can then make sure that those who need follow-up care receive it.

Tracking is the process of identifying high-risk patients and entering them into the practice’s follow-up system.

Recall is the monitoring and follow-up of these patients, arranging for the patient’s return when the provider recommends a test, follow-up exam, or treatment.

Many times, when there is a legal claim one of the following has occurred:

• The practice did not maintain close contact and follow-up with a high-risk patient.

• Referral to a specialist was not done and the patient never got to see the specialist.

• The patient simply disappeared from the practice and reappeared only when the disease had advanced.

It can be difficult to track every patient. For this reason, the practice should identify and focus their efforts on high-risk patients.  For most practices, there are two main types of high-risk patients.

 1. First are those with symptoms but still without a diagnosis. These patients need reminders to complete tests ordered, to return for follow-up exams, or to see a specialist when appropriate.

 2. The second type of high-risk patients are those who have been diagnosed with a serious disease or condition. They often need tracking and follow-up to remind them of recommended medical care.

The provider should identify which types of patients should be tracked and followed closely.

Patient tracking and recall duties usually fall to the practice’s staff.  But before a tracking and recall system can help a practice, it needs to have one in place.

Some systems are set up using the practice’s EMR.  All lab orders, patient appointments, and referrals are documented in the EMR.  The advantage of the EMR is that it can produce electronic reports telling the staff when these things are not completed within a certain time period.

Other systems are manual.  The practice maintains a written log of each lab order, test request, and referral that goes out of the office.  Selected staff members are assigned to monitor the log on a regular basis to identify missing reports.

Once the reports are back, the provider needs to review each report before the paper medical record goes back on the shelf.  If using an EMR, the provider should receive an electronic notice the report is back and sign off on it.

Once the provider has reviewed the reports, the provider should date and time the report and any required action.  If action is necessary, the provider will call the patient or delegate this task to a trusted staff member.  If a patient needs to be seen, enter them into the tracking and recall system to ensure that a timely appointment is made.

Patients should be notified of all lab and test results. All too often, practices tell patients, “No news is good news.”  This practice is not recommended. Often, medical liability lawsuits arise because an abnormal test got lost and no one noticed.  In most cases, the missing report was not noticed until the patient’s next appointment months later.  For many of these patients, the disease had advanced and the prime time for treatment had passed.

Practices can also remind patients about important screening exams.  If a patient refuses these screening exams patient refusals should be documented in the medical record.

Patients who are “no show” to their appointments often only require a phone call to reschedule them.  Notify the provider of all “no-shows” to make sure high-risk patients are identified.  Special attention will then be needed to ensure that the patient is re-scheduled and sees the provider in a timely manner.

Document all telephone calls, messages left for the patient and mailings.  These provide proof of the staff’s efforts to reach the patient.  Also, document the patient’s lack of response or actual refusal.  This documentation will be valuable if the provider must defend itself from a patient’s claim of missed or delayed care.

Sue Jones is senior risk management and patient safety specialist with the Cooperative of American Physicians. This article is one in a series.