This guidance applies to all sectors across health and care in England.

Aim

• to support and enable self-care and management
• to introduce safe timing, to reduce the risk of new diagnoses being communicated to patients by electronic means first

Principles

• all test results should be released to the person via a digital route when they have signed up to a patient engagement portal (PEP)/the NHS App
• at the time of requesting a test, there should be a conversation about the test; why it is required; potential results; and how the patient will be notified of the result, including by when and by whom
• when it is anticipated that there may be a new diagnosis for a patient, there should be a proactive plan for follow-up with the patient, within 21 days of the results being available to the clinical team. This will reduce the risk of a patient receiving this information (first) via a digital route
• all organisations will have a process by which they communicate abnormal results to an individual
• if the clinician is concerned about an individual’s response when they receive an automated result, this should be discussed with the person and/or their partner/carer. The clinician may wish to consider pausing – or advocate pausing – access to the PEP

Digital portal information and functionality

The PEP should:

• provide general information about tests and the availability timeframes of their results’, including how abnormal results will be communicated
• direct patients to appropriate resources to support understanding of their test(s) and the results
  • a good example is The Royal College of Pathologists’ LabTestsOnline website, which has been designed for public use
• notify patients which clinical team ordered their test(s), so the patient can contact the team for further information if required
• present quantitative results to enable review of individual test results, and trend views where there are repeat tests

The functionality of the portal should:

• enable the registered healthcare professional to add comments or notes
  • however, this is optional and should not delay the result being sent automatically
• allow manual override: where results have a delayed release, registered healthcare professionals should be able to override this and send a result sooner than the automation date where they consider it clinically appropriate
• permit the registered clinical professional to retract a released result (from those that they ordered)
  • there should be a justifiable and recorded reason why test results are retracted
• prevent pathology and radiology results from being released outside of working weekdays (that is, not on weekends or bank holidays), so that the recipient can access healthcare providers on the day of release if they need to
• make sure that people who have been admitted to hospital receive results in the same way as those who have not, and in the same timeframes

Timing of results release

Immediately:

• most quantitative tests
• obstetric ultrasound

No more than 28 days:

• histopathology
• radiology
• tumour markers
• antenatal screening (to be released after the antenatal follow-up appointment)

Never:

• genetic testing

* NHS England Diagnostics, in collaboration with The Royal College of Radiologists and The Society of Radiographers, is currently preparing national guidance for the automation of release of radiology results to patients.

In the first instance, there will be an expectation that radiology results will be automatically released in no more than 28 days, there is ambition to bring this down to 14 days.

Where providers are already releasing radiology results in less than 28 days, they should not extend this, noting that the expectation is to reduce.

Timeframe notes:

All timeframes are from the time of verified results.

The rationale for delaying radiology and pathology results is that these may be diagnostic. Delayed release allows time for a conversation about the result and implications, including a management plan.

This also means that the patient receiving results is in the position of being the ‘backstop’ in case the test result is missed. The balance of risk is that this way of working is better than there being a missed diagnosis.

Publication reference: PRN01315