Monitoring follow up of abnormal tests, especially abnormal cancer screens, is an ongoing challenge to providers in the office practice setting. Although physicians may view it as “the patient’s responsibility,” in the malpractice arena physicians have accountability for monitoring completion of abnormal tests and encouraging patient follow up. The following processes related to follow up have been identified from office practices in the CRICO/RMF community.

• Communicate the importance of follow up to the patient 
  Discussion with the patient regarding the significance of the abnormal result and the need for further testing (or treatment) is a vital first step. This should help provide appropriate motivation and encourage patients to assume accountability for follow through. Documentation of such discussions in the medical record is key to continuity of care and, if necessary, successful defense of an allegation of failure to diagnose.

• Develop a practice-based reconciliation process to monitor follow up of critical tests 
  Historically, tickler systems to monitor abnormal test result follow-up have been manual and frequently the responsibility of the individual provider. Practices that implement an electronic medical record system are able to convert such manual processes and redesign their work flow to automate and assign oversight to office staff, thereby increasing vigilance and reducing the individual physician burden.

• Initiate and document outreach efforts 
  With a reconciliation process in place, physicians can be fully aware of patients who have failed to follow up on worrisome tests and reach out to them (as appropriate to the need). Again, documentation of all outreach efforts is an important component of the process.

• Prominent display of the follow up plan 
  Prominent display of the follow up plan and its current status is important, especially for larger practices in which multiple physicians may provide care to the same patient. This display will provide visual cues to providers seeing the patient for an acute episodic visit, and remind them to reinforce compliance. Documentation should include both review of the need for follow up and the patient’s response.