• Document the conversation with the patient in which the doctor explains tests to be performed.
• Create checklists or prompts in assessment and order forms, reminding physicians to order tests.
• Ensure that referral forms are comprehensive and that they include the following information:
◦ Patient history
◦ Physical examination findings
◦ Test results
◦ Differential diagnosis
◦ Expectations of the consultation
◦ Urgency level
• Allow access to test results by consultants.
• Establish a test result management system to ensure all tests are completed. Standardized order forms combined with either an electronic or paper database should document:
◦ Complete list of ordered tests
◦ Review by physicians
◦ Follow-up with the patient
◦ Additional studies
◦ Space to mark when completed
• Require physicians to sign and date all of these forms with each step.
• Establish a dissemination policy for critical test results.
◦ Define which results require expedited, reliable communication, and develop critical test values.
◦ Define appropriate time parameters for action on critical test results.
◦ Flag critical results so they are acted on quickly.
◦ Establish criteria for escalating critical results to a back-up physician in the absence of the referring physician.