Urgent or clinically significant results

1. Governing standards & legal duties  (why this matters)

Source	Key duty
RACGP Standards 5th ed, Criterion GP2.2 B‑E – Follow‑up systems	Practices must have documented systems to identify, prioritise and recall patients with “clinically significant” or “high‑risk (life‑threatening)” results, including after hours. RACGP
NPAAC “Requirements for Information, Communication & Reporting” (2023)	Laboratories must directly telephone or secure‑message the requesting clinician (or delegate) with “critical/pathology alert” results and document the time, person and advice given. ACSQHC
Medical Board Code of Conduct §4.1 & 4.5	Doctors must arrange adequate follow‑up of investigations and act to “protect patients from risk of harm”. Medical Board of Australia
Medical‑defence risk advice (Avant, MDA National)	Coronial findings repeatedly criticise incomplete recall systems; insurers advise multiple, documented attempts using varied methods proportional to risk. Med Indemnity SolutionsMDA National

Bottom line: Failure to act on a critical result can breach the duty of care and attract negligence or disciplinary action.

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2. “RED” result rapid‑response pathway  (practical checklist)

Define the risk level first:
Critical / life‑threatening (“red”) → likely harm within hours‑days (e.g. +ve blood culture, grossly↑ troponin, INR > 9).
Clinically significant (“amber”) → serious if untreated within days‑weeks.
Routine (“green”) → standard recall/reminder system.

A. Immediate verification (within minutes) 

1. Confirm the result is yours (patient identifiers, time stamp, units, delta‑check).
2. Call the laboratory / radiologist back if clarification is needed or a second critical value is pending.

B. First‑line patient contact (within the timeframe set by clinical urgency)

Method	Caveats / tips
Telephone (preferred)	Call the mobile and any alternate numbers on record. ☑ Speak directly with the patient if possible. ☑ If voicemail: leave non‑specific message unless prior consent to disclose.
SMS / secure patient app	OK for “Please call the clinic urgently” messages; do not send the result itself unless patient consent & secure platform.
Email	Use only if patient consented to email comms and understands privacy risks.

C. Escalation if no response (typically after 2–3 documented attempts over ≤24 h*)

1. Check and update contact details in the clinical software.
2. Registered (or express) letter marked “Private & Confidential – Urgent Medical Matter”.
3. Next‑of‑kin / emergency contact – permissible under APP 6 (Privacy Act) when necessary to prevent “serious threat to life, health or safety”. Document rationale.
4. Welfare check (local police) or ambulance call where you reasonably believe the patient may already be unwell or at imminent risk (e.g. hyperkalaemia, critical INR and unable to contact).
5. Check local hospitals / MyHealth Record (if enabled) for recent presentations or admissions.

* Frequency & timing must match clinical risk (e.g. troponin ≥ 1 μg/L → attempts every 15‑30 min; asymptomatic ↑TSH → next business day).

D. Clinical handover if care passes to another service

• Document who you spoke to, what was conveyed, and the agreed plan (e.g. “3.15 pm: discussed K+ 7.1 mmol/L with ED registrar Dr Smith; ambulance dispatched to patient’s home”).

E. Documentation essentials

• Result details (date/time received, value, reference range).
• Risk category assigned and rationale.
• Every contact attempt: date/time, method, number dialled, outcome, message left, person spoken to.
• Advice given to patient / NOK / other clinician.
• Follow‑up plan (review booked, script faxed, ED referral, etc.).

F. System‑level risk‑reduction

Strategy	Why
“Results inbox” reconciliation each session and end‑of‑day cross‑check.	Prevents missed alerts after hours or when practitioner away.
Shared responsibility model (backup doctor / nurse).	Reduces single‑point failure (annual leave, illness).
Recall / alert flags in EMR with colour‑coding.	Provides visual cue of urgency.
Quarterly audit of random critical results.	Confirms protocol adherence (RACGP GP2.2 QI).
Patient education leaflet re: how/when results are communicated.	Sets expectations and encourages patient follow‑up.

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3. Review of your proposed steps

Your step	Keep / modify?	Comments
Contact patient urgently	✅ Keep.	Add documented risk‑based timeframe (e.g. ≤1 h for critical).
Send registered letter	✅ Keep as escalation.	Use after failed phone/SMS; ensure up‑to‑date address.
Contact next of kin	✅ Keep with privacy caveat.	Must be warranted by “serious threat” & minimal disclosure.
Contact pathology/radiology	✅ Keep.	Do this first if verification needed; also for alternate contact paths.
Check local hospital	✅ Keep as optional.	Usually after several failed attempts.
Contact emergency services	✅ Keep.	Only when you reasonably believe imminent risk and inability to reach patient.
“Three attempts” rule	⚠️ Refine.	No rigid number in guidelines; frequency must reflect risk level. May be >3 attempts within hours for life‑threatening results.

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Pearls

1. No single rule fits all – the higher the risk, the shorter the acceptable delay and the more intensive the contact attempts.
2. Privacy & confidentiality – limit content of voicemails/SMS; disclose to NOK only what is necessary.
3. Document contemporaneously – your notes are your best defence in a claim or coronial inquest.
4. After‑hours cover – ensure your practice has a policy for critical‑result alerts sent after closing (on‑call roster, secure email with auto‑forward).
5. Patient responsibility – even when protocols are robust, courts view urgent recall as a shared responsibility, not solely the patient’s job to “ring the doctor”.
6. Include locums / registrars – make sure every clinician using your provider number understands the practice’s recall SOP.

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4. Take‑home algorithm (quick reference)

VERIFY result →

RISK‑RATE (“red/amber/green”) →

CONTACT patient (multi‑modal) →

ESCALATE (NOK / police / ED) if unreachable →

DOCUMENT everything →

IMPLEMENT system improvements.