Positive results vary by clinical significance and can be classified as urgent or nonurgent, with others requiring no action.
The clinical significance of a test or result needs to be considered in the overall context of the patient’s history and presenting problems.
Systems will vary locally, but they should include processes for timely follow-up of positive results and cases where there is concern about the significance of a test result, e.g. persisting symptoms despite negative results.
Clinically accredited registered nurses within PFSHSs may be delegated management of test results including review, initialling (electronic equivalent) and actioned as outlined in the table below.
See RACGP Standards for general practices, System for follow up of tests and results.
Publicly Funded Sexual Health Services to have systems in place to ensure results are reviewed, documented, actioned and put in the patient’s medical record (paper or electronic).
Management of test results Results requiring urgent action by clinician Recommended action to be taken by clinician
- HIV antigen or antibody positive (indeterminate or equivocal)
- Recall patient on receipt of result
- The minimum follow-up is at least four attempts over two weeks, using two different notification methods (if available) and outside normal business hours
- If there is no response and a postal address is available, send a registered letter (person to person with a delivery receipt)
- Where the patient cannot be located or does not respond to contact efforts, seek advice from a senior clinician and consider HIV case conference with multidisciplinary team
- Additional measures may be possible through the SHIL partner notification service or local Public Health Unit.
- Document all attempts at contact
- Syphilis serology reactive, rapid plasma reagin (RPR) raised
- Syphilis nucleic acid amplification test (NAAT) swabs positive
- Chlamydia positive
- Gonorrhoea positive
- M. genitalium positive
- Glomerular filtration rate < 60 mL/min (if >60 mL/min see below)
- Hepatitis A immunoglobulin M (IgM) positive
- Hepatitis C RNA or antibody positive
- Lymphogranuloma venereum positive
- Trichomoniasis positive
- Cervical screening results requiring immediate referral
Results requiring review and action by clinician Recommended action to be taken by clinician
- Syphilis Treponema pallidum enzyme immune assay (EIA) positive; RPR serology nonreactive
- Herpes simplex virus (HSV) positive
- Hepatitis B surface antibody negative, surface antigen positive
- HIV monitoring results (chemistry, immunology, haematology)
- Cervical screening results not requiring immediate referral
- All nonroutine test results negative
- Hyphae or spores
- Candida albicans culture positive
- Clue cells
- Urine for molluscum contagiosum and syphilis showing any pathogen or microscopic findings
- Glomerular filtration rate 60–90 mL/min
- Any other positive, indeterminate or abnormal results not listed for urgent action
- All patients requiring immunisation
- Determine action required if any
- Co-ordinate subsequent follow-up in accordance with standard or local operating procedures
- If action is required:
- Recall patient within 7 days of receipt of result
- Make up to 2 attempts at contact in total at different times of the day
- If unable to contact patient, flag system to ensure follow-up at next visit
- Document all attempts at contact
No action required
- Where patient is not immune, recommend that they attend for vaccination.
Provision of test results
Results need to be conveyed to patients in a way that is meaningful for them and creates a shared understanding of what happens in the instance of a negative and a positive result. Two methods of patient contact should be recorded, noting the preferred method of contact.Provide timely convenient access to test results through phone, email and/or SMS (where available). Provision of results by telephone is an acceptable standard practice. Delivery of results in person can be organised where indicated.
Services may choose to implement a standard where the patient is contacted only when there is an abnormal finding. This type of ‘no news is good news’ method should be explained to patients having the test.
All actions are to be documented in patients medical record.
References and further reading
- RACGP Standards for general practices, System for follow up of tests and results.