Pre-Visit Laboratory TestingSave Time and Improve Care

Learning Objectives

1. List STEPS needed to implement pre-visit laboratory testing

2. Describe how to maximize patient compliance with the pre-visit laboratory process

3. Identify ways to delegate computerized order entry to the appropriate care team members

Pre-visit laboratory testing involves ordering patient laboratory tests at the time of the current appointment to be completed before the next appointment. Prospectively identifying the necessary pre-visit lab tests for the next visit allows the patient and physician to have a face-to-face conversation about lab results and options for care during the next visit.^1- 3 This process eliminates the need to review results later, saving time and improving patient care.

Pre-visit laboratory testing is a component of pre-visit planning described in detail in a separate toolkit.

1. Use a Visit Planner Checklist to Preorder Labs and Other Needed Tests for the Next Visit

2. Delegate Electronic Order Entry

3. Schedule the Next Follow-up Appointment

4. Arrange for Tests to Be Completed Before the Next Visit

5. Empower Team Members to Manage the Inbox

A visit planner checklist enables the physician to indicate the interval until the next appointment and schedule any associated labs. It should be quick and convenient to use, requiring no more than a few seconds of physician time. The visit planner is most useful if customized to the practice or an individual physician or specialty. For example, at the end of an office visit, a physician may schedule a patient with diabetes to return in 3 months to complete a fasting blood sugar and hemoglobin A1c (HbA_1c) before the visit. The result will be available to the patient and physician at the following appointment.

Quiz Ref IDIf patients miss the lab appointment, the appropriate team member can call them, invite them to come in for the test that they missed and, when appropriate, remind them of their upcoming appointment with the physician. This phone call can serve as a safeguard to reduce no-shows for office visits. The reminder call can also alert the team when the patient cannot keep their appointment with the physician so they can open up that time slot for another patient.

Quiz Ref IDAs described in STEP 1, using a visit planner checklist should only take a physician a few seconds. Entering the same information found on the checklist into a computer may require 1 to 2 minutes. Several minutes more per task can add up to hours per day.^3,5Delegating electronic order entry to another clinical team member allows physicians to focus on providing high-quality patient care.⁴

Scheduling patients for their next visit at the conclusion of the current visit saves time, promotes continuity, and may improve adherence to follow-up visits.⁴ It also signals to patients that you want to see them again and will plan ahead to make their visit as meaningful as possible.⁵

Many practices find that scheduling 1 year or more in advance saves the care team time. Some patients will have to call to reschedule, but this is less work for both patient and practitioner than a system that requires all patients to call to schedule their next visit.

Some practices that choose not to book 1 year or more in advance instead create a system to store appointment times and associated lab requests and then contact the patient 2 weeks before the due date to schedule both the appointment and any pre-visit laboratory tests. Others will send the patient a postcard asking the patient to call in. While these approaches require more “touches,” they are reasonable alternatives for clinics that do not schedule a year in advance.

While scheduling patients for their next office visit, simultaneously schedule any labs or additional tests and scans before the next office visit. Some organizations arrange for patients to have lab testing a few days before their appointment with the physician. In contrast, others have developed processes for rapid turnaround of the lab testing and results so that the patient may come for the lab test earlier on the day of their appointment with the physician. Each approach aims to have the lab results available at the visit so the physician and patient can discuss them face-to-face.^1- 3

Monitoring a condition at appropriate intervals through pre-visit laboratory testing allows the patient and physician to complete all management decisions during a visit. This is more efficient than having the results return slowly to the office, generating multiple phone calls and additional follow-up work for the physician and care team to conduct.^4,6

Team members can use physician-established protocols to review results and forward only those that are abnormal to the physician. This way, the physician reviews most labs only once—at the time of the appointment. This is known as “just-in-time” information processing. For example, suppose a team member reviews a patient's lab results for urgent abnormalities before a visit and finds none. In that case, the physician will only need to review the results once at the time of the patient's visit.^2- 4

Scheduling future appointments and pre-ordering needed laboratory tests before the next visit sends the right message to patients—their care team is proactively preparing for their next appointment to ensure efficient use of time at each visit.⁶ Patients who are more actively involved in their own care generally experience better health outcomes and regularly obtain preventive care, such as having lab work done at the appropriate intervals.⁴ Additionally, this approach encourages the team to take a more active role in reviewing laboratory results to support the physician during a visit.

Journal Articles and Other Publications

• Sinsky CA, Willard-Grace R, Schutzbank AM, Sinsky TA, Margolius D, Bodenheimer T. In search of joy in practice: a report of 23 high-functioning primary care practices. Ann Fam Med. 2013;11(3):272-278. doi:10.1370/afm.1531

• Vrijsen BEL, Ten Berg MJ, Naaktgeboren CA, et al. The impact of a standardized pre-visit laboratory testing panel in the internal medicine outpatient clinic: a controlled “on-off” trial. J Gen Intern Med. 2021;36(7):1914-1920. doi:10.1007/s11606-020-06453-2

• Crocker B, Lewandrowski EL, Lewandrowski N, Gregory K, Lewandrowski K. Patient satisfaction with point-of-care laboratory testing: report of a quality improvement program in an ambulatory practice of an academic medical center. Clin Chim Acta. 2013;424:8-11. doi: 10.1016/j.cca.2013.04.025