Tom is a newly qualified GP who has been struggling to manage his laboratory results…
In his training practice he was only given a few results to review and would ask his clinical supervisor for advice when he was uncertain about what to do. He thought he would be fine, though has found that he often struggles to decide how he should manage some abnormal results.
Tom decides to ask Fatima, a more experienced salaried GP who works at the practice for help…
He shares with her some examples of common blood results that he has struggled to manage.
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Marginally low/high white cell count
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Marginally low leucocyte/neutrophil/eosinophil count
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Slightly low platelet count
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Raised ALP on liver function tests
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Raised triglyceride count
Fatima tells Tom that she also feels uncertain managing these blood results at times…
After speaking with the other GPs, Fatima and Tom arrange a practice team update session on managing borderline blood results.
Together the team review blood results pending review. The team discuss causes of low or high white cell counts, a high ALP and raised triglyceride levels. The session helps build everyone’s confidence a little, but many team members recognise that they still find managing the borderline results hard.
Tom is surprised by how much individuals differ in their opinions about how to manage borderline results.
Some discuss how they look at trends or repeat tests at interval, whilst others have a higher threshold of concern. He comes to appreciate that there are no definite answers for some borderline results, but decisions made can be informed by review of past results, the reason for testing and the patients’ current clinical condition.
Tom recognises that it would be helpful to have more information when interpreting results. Fatima, who subscribes to WiseGP discusses their work which recognises the importance of having all the contextual data to help clinicians create tailored explanations of results.
The practice team agree that all clinicians will include more clinical details on their blood request forms to aid interpretation of results on review, so clinicians can more readily understand the clinical context.
Fatima has completed the WISDOM course and recognises the importance of working within a community of practice.
She suggests two approaches:
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Buddying systems for review, where people are paired with a colleague who they can seek advice from on blood results.
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A regular team meeting to discuss blood results team members have found challenging to manage.
After the meeting the whole team feel more reassured that they can discuss any cases of clinical uncertainty with each other and plan to build these opportunities into their working week.
Tom recognises that there isn’t necessarily a right and wrong answer, but that results need to be interpreted in their individual context. He now feels more able to create an explanation about abnormal results to help him develop a management plan, which he can test and review if necessary.
He describes feeling more empowered to help his colleagues by avoiding arranging unnecessary telephone follow-up appointments. The whole team feel the discussion has helped them all reduce the burden they place on patients through repeated blood tests.
With the support of colleagues, Tom has developed skills in managing uncertainty when reviewing blood test results, which will save him time in future. His wider practice team have also benefited from discussing laboratory result interpretation.
Read more about how to save time in practice, in our WiseGP newsletter entitled “Against the Clock…”
