Improving Access to Cardiology through a Collaborative Model of Shared Care
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Transcript of Improving Access to Cardiology through a Collaborative Model of Shared Care
Improving Access to Specialist Care
JCC Showcase February 24, 2016
Dr. Ken Gin, MD, Division Head, Cardiology, VGH, Clinical Professor, UBC
Dr. Joy Russell, MD, Vancouver Division of Family Practice
Moe Baloo, DC, MHA, Providence Health Care
Shared Care Cardiology-Family Medicine Working Group
Purpose: To improve collaboration, cooperation, and communication between Cardiologists and Family Physicians
Objectives:
• Streamline the cardiac patient journey
• Improve the Cardiology-FP Referral Process (including timely acknowledgment and triage)
• Clarify SP-FP roles, responsibilities, and expectations
• Improve Consultation and Follow-up
• Enhance Cardiology-FP relationships
Priority-Setting Exercise:
From our discussions so far, what are your biggest priorities?
Priority 1 - Referral Process • Triaging • Avoiding duplication • Referral acknowledgement • Referral options
Priority 2 - Roles and Responsibilities
• Clarity around co-management • Who is responsible for what? • Whose patient is this?
Priority 3 - Consultation and Follow-up
• Consultation letter • Clarity is provided and questions are answered • Trust that bi-directional follow-up will occur
Priority 1 - Referral Process
• Overarching goal is to improve communication and coordination around cardiology referrals:
• In particular:
o Acknowledgement of receipt of the referral within 7 days or less
o Triage referrals based on risk
o Provide specialist appointments within 1-3 weeks
o Speed up consult letter with a target of 72 hours
o Implement a common referral form, first within Vancouver, then across VCH
Why Those Particular Goals?
Survey Results of FP’s Reporting Challenges with Referral Process
Source: Marla Steinberg, Ph.D., June, 2015
Common Referral Form • Key elements include options
to refer directly to a specific cardiologist or outpatient clinic at VGH, SPH, LGH, and RH
• Currently, each clinic (~30) uses its own referral form
• Referral Acknowledgment is embedded and a SP or clinic fax-back is requested within 72 hours (3 business days)
CARDIOLOGY REFERRAL
REFERRING PROVIDER:
GP NP ED Specialist (specify)
Name:
MSP #:
Address:
Phone:
Fax:
Date:
PATIENT INFORMATION
Name:
PHN: Male
DOB: (dd/mmm/yy) Female
Address: Transgender
City: Province:
Postal code: Email:
Home phone #
Cell:
Work:
Language(s) spoken:
~If this patient does not speak English, please ask them to bring an interpreter~
Outpatient Inpatient – site:
REFER TO: Specific Cardiologist: ____________________ OR Specialty Clinic (See page 3 for clinic information)
SEVERITY OF SYMPTOMS: Severe Moderate Mild Asymptomatic
URGENCY:
If unsure of urgency, call the RACE line at 604-696-2131
Emergent (Immediate to 24 hours) Call Cardiology or send to ED
Urgent (within 2 weeks) Reason:
Semi-Urgent (within 4 weeks)
Elective (an attempt will be made to see patient within 12 weeks)
Has this patient been seen by a Cardiologist before? No Yes
Name: Date: Is this a Re-referral? No Yes
REASON FOR REFERRAL:
Please include recent relevant medical history, See attached: Consult notes Medication list medication records, investigations and lab results. Lab results Allergies/Drug Intolerances
PREVIOUS
INVESTIGATIONS:
Done Date Attached Not Done Comments
Chest x-ray
ECG
Exercise tolerance test
Holter Monitor
Cardiac Echo
Coronary angiogram
Cardiac CT/MRI
MIBI test
Other Cardiac tests
This referral will be triaged by cardiology staff. For prompt booking, please ensure all sections are fully completed.
ACKNOWLEDGEMENT OF REFERRAL (to be completed within 72 hours)
Our office will make an appointment with your patient within the next (days or weeks)
Your patient is booked to see a specialist on: Date: Time:
We will notify your patient of the above appointment Please notify your patient of the above appointment
We require the following additional information before we can book an appointment for this patient:
Common Referral Form
• The form also serves as an education piece for family physicians, NP’s, and other specialists by providing a concise description of services provided at each clinic
Referral Form Evaluation Summary
• 72 referrals were faxed between January 1 – March 31, 2015
• 75% were acknowledged
• Average time to acknowledgement was 5 days (range 0 to 26 days)
42% were within 72 hours
• Average time to appointment was 34 days
• 82% of the referrals went to a specific cardiologist
• 18% went to a VGH or SPH cardiology ambulatory clinic
Evaluation Summary (Based on pre- and post survey questions)
• All FP’s reported an increased knowledge of
cardiology services in Vancouver
• 38% of SPs said that referrals contained more complete information compared to 6% prior to the form
• Overall, 67% of FPs and 62% of SPs said the referral process had improved when using the form
Nice to get acknowledgment back in a timely
manner (GP)
It feels better that it’s actually
received and triaged (GP)
Challenges & Next Steps
• How do we ensure continued support from five distinct tertiary sites?
• How do we ensure patient care is kept ‘closer to home’?
• How can we improve the process for both the referring physician and receiving specialist? (EMR integration, etc.)
• How do we know if we’ve truly improved timely access to specialist care?
Thank you.
Questions?