Risk Reduction Resources

Results Management

Tracking Diagnostic Tests and Referrals

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Purpose. Provide a reliable, closed-loop process for diagnostic tests, procedures, and referrals from the time an order is placed through completion of clinically necessary follow-up.

A reliable results-management system helps prevent missed or delayed diagnosis by ensuring that every order has a responsible clinician, a clinically appropriate due date, a documented disposition, and a defined escalation path. The system should include tests performed inside and outside the organization, referrals, consultation reports, pathology, imaging, laboratory studies, screening tests, and other diagnostic procedures.

Closed-Loop Standard

An item is not closed merely because a result or consultation report was received. Closure occurs only when the required steps have been completed and documented, or when the responsible clinician makes and documents an informed decision that no further action is required.

• Order entered and successfully transmitted to the intended facility or specialist.
• Responsible ordering and follow-up clinician identified.
• Clinical priority and expected completion/reporting timeframe assigned.
• Test, procedure, or referral scheduled or otherwise dispositioned.
• Test, procedure, or consultation completed.
• Result or consultation report received and matched to the correct patient and order.
• Result reviewed and acknowledged by an authorized clinician.
• Patient notified in understandable language using an appropriate communication method.
• Recommended treatment, repeat testing, referral, or other follow-up initiated and completed when clinically necessary.
• Final disposition and closure documented.

Written policy and accountability

The practice should maintain a written policy that assigns responsibility for each step, defines required timeframes, and describes escalation when a step is overdue. The policy should address ordering clinicians, covering clinicians, clinical and administrative staff, consultants, laboratories and imaging facilities, and transitions of care.

• Identify the clinician responsible for reviewing the result and for ensuring completion of required follow-up.
• Define how responsibility is reassigned during leave, vacation, termination, retirement, inbox reassignment, or other unavailability.
• Prohibit closing or deleting an order solely because the patient did not respond, the report was not received, or the ordering clinician is unavailable.
• Maintain a fail-safe work queue, registry, or exception report that is reviewed at a defined frequency by assigned staff.
• Define first-level and higher-level escalation, including who is notified and when.

Core workflow

1. Order and transmit: Enter the order in the EHR or approved tracking system; confirm the correct patient, test or referral, indication, priority, destination, responsible clinician, and successful transmission. Provide the receiving organization with relevant clinical information and clearly state whether the referral is for consultation, co-management, or transfer of care.
2. Set risk-based deadlines: At the time of ordering, assign an expected completion date and expected reporting date based on clinical urgency, the patient’s condition, and normal turnaround time. A single universal interval, such as two weeks, should not be used for all orders.
3. Monitor completion: Use an EHR work queue, registry, or controlled paper process to identify orders that have not been scheduled, completed, or resulted by the assigned due date. Contact the patient and/or receiving organization as appropriate and document each action.
4. Receive and reconcile: Match every result to the correct patient and order. Identify results that arrive without a corresponding order, duplicate results, results sent to the wrong clinician, and ordered tests for which no result is received.
5. Review and acknowledge: Route results to the responsible clinician. The record should show who reviewed the result, the date and time of review, the clinical interpretation when needed, and the required next action. Configure escalation for unacknowledged results.
6. Communicate with the patient: Notify patients of normal and abnormal results within policy-defined timeframes. Explain the meaning of the result, recommended next steps, warning signs, and whom to contact with questions. Do not depend on a future appointment as the only means of communication.
7. Complete follow-up and close: Track clinically necessary repeat testing, treatment, referrals, and other recommendations to completion. Document the final disposition and the identity of the person closing the item.

Critical, urgent, and clinically significant results

The practice should define categories and timeframes for critical, urgent, and other clinically significant results in collaboration with laboratories, imaging providers, and consultants. The urgency of communication should reflect the risk of harm.

• Identify which trained roles may receive verbal critical or urgent results.
• Use at least two patient identifiers and perform a complete read-back of verbal results.
• Require positive acknowledgment by a responsible clinician and document the date, time, sender, receiver, result, read-back, notification, and action taken.
• Use automatic escalation when a result is not acknowledged within the defined timeframe.
• For life-threatening or time-sensitive findings, use direct verbal communication and confirm receipt; do not rely solely on an unread portal message, voicemail, text, fax, or routine inbox notification.

Amended and corrected results

The system should clearly identify preliminary, final, corrected, and amended reports. When a result changes, notify the ordering clinician and any other clinician responsible for follow-up. Clinically significant changes require direct communication, reassessment of the plan, renewed patient notification when appropriate, and documentation of all actions.

Patient portals and electronic access

Portal release does not replace clinician review, patient communication, or follow-up. Policies should support timely electronic access to health information and should not impose blanket delays unless a specific, lawful exception applies. Practices should explain that some results may appear before clinician review and provide clear instructions for questions and urgent concerns.

• Document the release method and any additional communication or instructions.
• Do not assume that every patient uses or can access a portal.
• For actionable abnormal results, monitor delivery or portal status when available and use another method if receipt is not reasonably assured.
• Address language, disability access, proxy access, adolescent confidentiality, behavioral-health or substance-use information, and patient communication preferences.

Voicemail, text, email, and other communication methods

Use communication methods permitted by organizational policy and consistent with patient preferences, reasonable privacy safeguards, and applicable law. Unless the patient has agreed otherwise, limit voicemail content to the practice name, callback number, and a request to return the call. Do not include sensitive result details in an unsecured message. Critical or time-sensitive results require direct communication and escalation until receipt is confirmed.

Patient noncompletion and barriers to follow-up

When a patient does not schedule, complete, or respond to recommended follow-up, assess the clinical risk and identify barriers such as cost, transportation, language, health literacy, caregiving responsibilities, fear, or scheduling difficulty. Reasonable efforts should be proportionate to the risk.

• Document each contact attempt, method, date, outcome, and instructions provided.
• Notify the responsible clinician and obtain direction for additional outreach or an alternative plan.
• Use alternate authorized contacts or written notification when appropriate.
• For significant unresolved risk, clearly explain the potential consequences of noncompletion without using punitive or moralizing language.
• Document the clinician’s final disposition; do not close the item solely because the patient could not be reached.

Referrals and consultation reports

• Log the referral, clinical priority, reason, destination, responsible clinician, and expected appointment and report dates.
• Confirm successful transmission of the referral and relevant records.
• Track whether the patient scheduled and attended the appointment.
• Track receipt, review, and acknowledgment of the consultation report.
• Clarify whether care remains with the referring clinician, is shared, or has transferred for a defined condition.
• Track and complete recommendations that remain the referring practice’s responsibility.
• Escalate referrals that are not completed or reports that are not received within the risk-based timeframe.

Unsolicited, misdirected, and unmatched reports

Review every incoming report sufficiently to determine the correct patient, intended recipient, clinical significance, and safe disposition. Do not silently delete or disregard an abnormal report because it was unsolicited or misdirected. Verify the intended recipient, notify the sender, use secure transmission, document disposition, and evaluate possible privacy or patient-identification events under organizational policy.

EHR and downtime safeguards

• Test interfaces and routing rules when systems, locations, clinicians, or vendors change.
• Monitor results sent to the wrong clinician, results never transmitted, duplicate orders, interface failures, and unmatched results.
• Provide backup coverage, forwarding, reminders, and role-based work queues.
• Maintain a downtime and recovery process that reconciles orders and results entered or received during the outage.
• Periodically reconcile a sample of orders against results to identify silent failures.

Documentation

The medical record or approved tracking system should document the order, responsible clinician, priority, due dates, scheduling and completion status, receipt and acknowledgment of results, clinical interpretation when needed, patient communication, contact attempts, recommendations, escalation, completion of follow-up, and final closure. Avoid relying on initials alone when the system can identify the individual and timestamp the action.

Quality monitoring

• Orders completed by the expected date and results received by the expected reporting date.
• Results acknowledged within the policy-defined timeframe.
• Critical and urgent results communicated and escalated within required timeframes.
• Time from abnormal result receipt to patient notification and required action.
• Unread actionable portal messages and unsuccessful contact attempts.
• Referrals without completed appointments or consultation reports.
• Amended results requiring revised action.
• Orders closed without a documented disposition.
• Wrong-recipient, wrong-patient, interface, and routing failures.
• Aging of open items by urgency and responsible clinician.

Staff education

Train staff at orientation, when workflows or technology change, and periodically thereafter. Training should address responsibilities, urgency categories, privacy safeguards, escalation, documentation, portal workflows, downtime procedures, and how to report process failures without fear of retaliation.

Resources

Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology. (2025). SAFER self-assessment: Test results reporting and follow-up. https://www.healthit.gov/wp-content/uploads/2025/06/SAFER-Guide-8.-Test-Results-Reporting-Final.pdf

Steitz, B. D., Turer, R. W., Lin, C.-T., MacDonald, S., Salmi, L., Wright, A., Lehmann, C. U., Langford, K., McDonald, S. A., Reese, T. J., Sternberg, P., Chen, Q., Rosenbloom, S. T., & DesRoches, C. M. (2023). Perspectives of patients about immediate access to test results through an online patient portal. JAMA Network Open, 6(3), Article e233572.

The Joint Commission. (2019, December). Advancing safety with closed-loop communication of test results (Quick Safety, Issue 52). https://digitalassets.jointcommission.org/api/public/content/77c6421712dc463eae4b2398f9bf01a5

U.S. Department of Health and Human Services, Office for Civil Rights. (2022, December 28). May physician’s offices or pharmacists leave messages for patients at their homes, either on an answering machine or with a family member, to remind them of appointments or to inform them that a prescription is ready? May providers continue to mail appointment or prescription refill reminders to patients’ homes?

This practice tip provides risk management guidance and should be adapted to applicable federal and state law, accreditation requirements, professional standards, payer requirements, and the capabilities of the organization’s EHR and communication systems.

Updated on: 10/2026