Inpatient 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 inpatient settings for hospitalized patients. The assumption is that a result relates to an intervention (test, procedure, etc.) that is ordered within Connect Care.
An important distinction relates to where orders are intended for action:
Relate to tests or interventions that are performed as part of the patient's inpatient care, even if the sample needs to be sent to an external testing facility to get the assay done, and even if the result is not returned (or expected) until after patient discharge.
Are entered with intent that the test or procedure be performed after the patient has been discharged.
Are special cases where an inpatient is sent to an external facility (e.g., clinic, diagnostic imaging) where test orders may be entered and that facility does not use Connect Care as its record of care.
Prescribers need to be aware of how these distinctions affect the routing of results to the chart and possibly In Basket or other communication pathways.
Results relating to orders placed within an inpatient encounter are, with few exceptions, managed within that encounter. There is no default routing to In Basket or other communication channels. The assumption is that an attending prescriber, supported by an inpatient care team, is responsible for regular review of the chart for new information that relates to the encounter. This is usually done on rounds. Internally ordered results return to the chart only, and are not sent to prescriber In Baskets.
Exceptions include results that are:
Results that relate to inpatient orders, where the final result becomes available AFTER the patient has left the inpatient admission (discharge, deceased, left against advice, etc.), are routed to the In Basket of the attending prescriber who was attached at the time of discharge.
Protocols for critical result notification match practices followed before Connect Care. In general, the attending prescriber is contacted. 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). There may be facility or lab-specific variances.
Prescribers whose name is 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.
Even though the majority of inpatient results are not In Basket-routed, prescribers can mark specific tests for explicit notification. This is useful when there are high-stakes results that the clinician needs to review as soon as available; before the chart might otherwise be checked.
When inpatient prescribers arrange for interventions to be performed AFTER discharge, these are considered external orders. The action occurs outside of the hospital encounter. External orders may be entered in the discharge navigator or in the "external orders" section of the Orders activity. Consultants may use the latter to ensure that post-discharge tests support of follow-up specialty services anticipated in clinic.
External orders behave just like outpatient orders. The result will be 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.
Patients may go on a leave of absence for an intervention to be performed at another facility. If tests are ordered at that facility then associated results will generally return to the ordering prescriber, often copied to the requesting 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 a leave of absence for procedure or an interfacility transfer with return.