Emergency Department Results and Reports Routing
This section highlights how laboratory test results and diagnostic imaging reports (“results” hereafter) are delivered (“routed”) to prescribers who use Connect Care as the record of care in Emergency Department (ED) and Urgent Care (UC) settings ("ED" hereafter). The assumption is that a result relates to an intervention (test, procedure, etc.) that is ordered within Connect Care.
In general, results associated with tests ordered in ED become available during the ED patient encounter. These are reviewed in the chart (Chart Review or other laboratory result displays in ED navigators) and do not route to In Baskets. Attending prescribers who take over from a colleague while a patient is still in ED assume responsibility for monitoring new information appearing in the patient's chart. Results that return after a patient has left (been discharged from) the ED deserve special attention, as they need to be handled in a way that ensures review. This section focuses on late reporting, critical and copied results.
ED Results Message Pool
Medical and operational leaders at each ED site make arrangements for one or more ED results management (In Basket) messaging pool(s), together with scheduled membership and accountability for messages arriving to that pool. Usually, a "Pool Manager" is designated for a site and can be contacted to have a prescribers name added or removed from the message pool protocol.
Late Reporting Results
The outcomes of most tests and procedures are usually available for review while both patient and prescriber are in the ED. However, EDs also manage results that return after a patient has been discharged from the ED or UC (“late results”).
EDs should manage late results in a way that prioritizes:
Clear documentation in the Connect Care chart
The ability of a collective group to assist individual prescribers with managing late reporting results
Decisions regarding how best to manage late reporting results in Connect Care are made at the departmental level, determined in advance of launch by site leadership, with compliance expected of all department members. Usually an ED Result Follow Pool (supervised In Basket destination that is monitored by a group of staff and/or prescribers) is used in accordance with one of the following workflows:
Workflow A - Authorizing Prescriber Only
Late results return to the Authorizing Prescriber only, with an ED Result Follow Pool used to capture only the few results not attached to a prescriber.
Workflow B - Authorizing Prescriber and Pool - Abnormal Only
Abnormal late results return to both the Authorizing Prescriber and the ED Result Follow Pool, and all other results return to the Authorizing Prescriber.
Workflow C - Authorizing Prescriber and Pool - All Late Results
Both abnormal and normal late results return to both the Authorizing Prescriber and the ED Result Follow Pool.
Some ED orders are activated as part of a triage protocol, even before an authorizing prescriber is assigned. These may rarely result after the patient leaves the ED or UC. The results are routed to an ED Result Follow Pool, which each ED needs to staff and supervise.
Some ED prescribers work at more than one site, with the possibility that different late-reporting result practices apply at different sites. Prescribers who find themselves subject to multi-department policies need to understand what is expected of them from each department and that late routing responsibilities only apply to tests that were ordered (and the specimen taken) during an ED visit.
Results relating to orders placed within an ED encounter that result while a patient is in the department are usually managed within that encounter. Special considerations include:
Protocols for critical result notification match practices followed before Connect Care. In general, the patient's attending ED prescriber is contacted, as well as the ED. If this information, or the attending, is not available, then the authorizing or on-call prescriber is contacted. The same applies for late-resulting (post-discharge) critical results (a rare occurrence).
Prescribers whose names are added to a copy-list at the time of ordering always receive the associated result via their default communication pathway (In Basket for Connect Care prescribers), irrespective of when the result or report becomes available. It is important to take advantage of this copy function to ensure that interested clinicians (e.g., consultant, primary care provider) are alerted to tests that relate to an accountability surviving beyond the hospital encounter.
Until all sites across the province are live on Connect Care, any test sent through Provincial Laboratories (e.g., syphilis testing) is resulted to the Authorizing Prescriber only. The only reliable way to have these results routed to a pool is by utilizing the “CC” function at the time of ordering the test.
When ED prescribers arrange for interventions to be performed AFTER a patient is discharged from the ED, these are considered "external orders". They can be placed as discharge orders or as external orders within the Orders activity.
External orders behave like outpatient orders, returned to the authorizing (ordering) prescriber via the default communication pathway for that prescriber (In Basket for Connect Care prescribers). If results for post-discharge interventions should be received by another prescriber (e.g., family physician, consulting specialist), then that prescriber's name should be added to the copy list at the time of ordering. Sometimes the follow-up happens through a planned return to the ED, when the attending prescriber for that ED visit will have access to the results via the Connect Care chart.
Patients may leave the ED for an intervention to be performed at another facility before the patient is returned to ED. If tests are ordered at a different facility, then associated results will generally return to the ordering prescriber, often copied to the requesting (authorizing) prescriber. Since the patient returns to the host facility, the expectation is that the responsible prescriber(s) will use Chart Review to check for results associated with an intrafacility or interfacility transfer with return.