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According to the RCEM guidance, the person requesting a result ultimately has responsibility for it being reviewed and acted on.

Somerset Community Health’s consultant nurse in community urgent care Mike Paynter, who leads seven minor injury units, explains: ‘You may request for one reason and find something else. Incidental findings can be time-critical and need to be reviewed in a specified time frame. If you’re the requestor, it is your responsibility to make sure the patient is directed to someone who can follow that up.’

All EDs should have a standard operating procedure that covers this and other issues surrounding the management of such results, according to the RCEM.

What should nurses consider if results are pending when they hand over shift?

‘Significant mistakes are made when vital information is missed during handover,’

Mr Paynter says. ‘If I see someone with a wrist injury and send them for X-ray, and then my shift finishes, and I’m not clear with the nurse I hand over to, then they might think we’re only checking the X-ray for a plain wrist view, rather than a scaphoid bone in the wrist.

‘That means they’ll only check two views, as is the case with a plain wrist, rather than the four views needed for scaphoid. It’s an easy mistake to make, and if you don’t know the history and don’t scroll up and down properly, you can easily miss the fracture and send someone home.’

Who is responsible if a patient is later referred to an in-patient team?

The RCEM guidance explains that if results arrive more than four hours after a patient is seen in the ED, and the person is now in another inpatient area of the hospital under a different team, the responsibility for reviewing and acting on the result lies with the new team and not with the ED.

‘If I refer a patient to the surgical team and they accept them, my job is done,’ says Mr Paynter. ‘The subsequent management is with that new team.’

How should abnormal test results not requiring immediate treatment be recorded?

Ideally, all test results should be recorded in an electronic patient record, the RCEM states.

University of the West of England senior lecturer for advanced practice Rebecca Hoskins is a consultant nurse and former ED matron.

She says: ‘Even though results are electronic, there is still often the question of whether primary or secondary care should follow-up abnormal results.

‘If a result doesn’t need to be acted on in 24 hours, it is for primary care, and that needs to be written into the discharge summary.’

How can nurses keep patients informed and show sensitivity when managing results?

Dr Hoskins says that as a former matron, she has seen people receive cancer diagnoses in the ED.

‘If the patient is going to be told life-changing news, you need a proper multidisciplinary team discussion beforehand,’ she says. ‘Don’t just consider support at that moment, because most people won’t take in a lot at that time. The follow-up support is so important.’

Can a patient be discharged before all their results are known?

The RCEM says primary care teams should be informed if patients are discharged while results are outstanding, so nothing is missed.

‘If it’s not time-critical, you can discharge a patient while results are pending,’ says

Mr Paynter. ‘But it’s all about the follow-up and communication. It cannot be vague. So, you need to say: “You need to call us on this number at this time for this result.”’

What is ‘safety-netting’?

Safety-netting is information given to a patient or their carer during a consultation, about actions to take if their condition deteriorates, changes, or persists. Often, nurses will tell patients when they should book follow-up appointments and how. There is no particular guideline or set of standards that advises what safety-netting should involve or how it should be delivered, as it is specific to the situation.

‘We know safety netting is effective, which is why it is considered best practice,’ says

Dr Hoskins. ‘It protects the patient and nurse should the condition worsen. Trusts and departments will have their own policies on what it should include.

‘What you’re trying to ensure is that the patient is safe once they leave that particular clinical setting. So, you’re telling the patient what they should expect of the condition, what symptoms to look out for that could mean their condition is worsening, and what they should do if that happens.

‘Those are the basics. But you can include information on self-management and self-monitoring,’ adds Dr Hoskins.

‘But we need to be honest about the trajectory of a patient’s illness or injury. It’s better to say “a sprain can take a couple of weeks to heal”, rather than “good news, it’s a sprain and not a break”. With that second example, the patient thinks “great, I can go back to work tomorrow”, and is then back for follow-up.’