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Recall and Reminder Policy and Procedure Manual  Medical Director  Contains the practice policy plus all relevant procedures  

2010

Tracey Roebuck [GP Association of Geelong] 

1/9/2010 

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Table of Contents

RECALL & REMINDER FOLLOW UP POLICY ........................................................................................ 3 

PROCEDURE MANUAL ............................................................................................................................... 5 

1.  Follow-up Procedure: .................................................................................................................... 5 

2.  Sample Patient Information Sheet ................................................................................................. 7 

3.  Recall letter for patients unable to be contacted by telephone ...................................................... 8 

4.  Reminder Letter ............................................................................................................................ 9 

5.  Cleaning up the Recall Menu ...................................................................................................... 10 

a)  Adding Reminder Reasons to the Menu .................................................................................. 10 

b)  Deleting Reminder Reasons from the Menu ........................................................................... 12 

c)  Linking Current Reminders with a New Reminder Menu Protocol ........................................ 13 

6.  Adding a Recall to a Patient File ................................................................................................ 15 

7.  Removing a Recall (So it is removed from recall searches) ....................................................... 16 

8.  Creating Recall Search Lists ....................................................................................................... 17 

 

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RECALL & REMINDER FOLLOW UP POLICY Policy Purpose: To ensure follow up of significant tests, results and referrals

Responsibility: It is the responsibility of GPs ordering tests, investigations or referrals, to set up a reminder prompt to

check for expected returning results, reports and correspondence, and to initiate a system of follow up

as required (for missing results / reports/ correspondence)

It is the responsibility of the GP to check all incoming results, reports and correspondence, and to

initiate follow up as required.

It is the responsibility of the practice nurse to conduct the monthly follow-up searches and alert the GP

where tests, correspondence from specialists have not been received, or where patients have not

responded to recalls.

It is the responsibility of reception to alert the relevant health practitioner when a patient fails to attend

a recall appointment.

It is the responsibility of all health practitioners within the practice to alert a patient to an overdue

recall/ reminder if detected.eg “ It appears as though your Pap Smear is overdue. Can you make an app.

to see your GP ASAP?” This verbal reminder should be documented in the patient file.

Policy

Statement:

It is the policy of ……………........Medical Centre that all patients will receive follow-up where it is

deemed clinically significant. Follow up can mean:

Follow-up information: eg where tests, results, correspondence has not been received back at

the practice

Follow-up the patient:

√ To discuss reports, tests, results, correspondence and then treat.

√ To follow up the patient where they have not attended a specialist referral or had ordered tests/ investigations

√ To perform preventive health checks or to manage a known condition

The level of risk related to failure to follow-up increases with the level of clinical significance of tests,

results/ referrals that were ordered. The GP or the nurse will use clinical judgement to decide the level

of significance of the referrals and tests ordered in order to determine whether a recall should be set.

Clinically significant tests, results, correspondence are followed up according to procedure 1.5

All staff at this medical practice is aware of the need for confidentiality and discretion, with regard to

results, reports and correspondence. The practice is proactive about maintaining current contact details

for patients of this practice. Information about the reminder recall system is provided via waiting room

notices and patient information sheets. Patients may opt out of the system. This decision to opt out is

recorded in the patient file.

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Policy

Implementatio

n Strategies:

………………. Medical Centre ensures that the relevant staff members are trained in the use of the

recall and reminder system.

Prompt sheets for all aspects of the recall and reminder system are available and filed in the Practice

Policy and Procedure Manual (see document list below).

Training in recall and reminder software systems for new staff members can be sourced from the GP

Association of Geelong.

Quality

Assurance

Mechanisms

This policy shall be reviewed within ……months to ensure its continuing efficacy

Relevant

Procedure

Documents:

1. Follow-up Procedure

2. Patient Information Sheet and Opt Out Form

3. Recall letter for patients unable to be contacted by telephone

4. Reminder Letter for a routine check

5. Cleaning Up The Recall Menu

6. Adding a Recall

7. Removing a Recall

8. Creating Recall Search Lists

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PROCEDURE MANUAL 

1. Follow­up Procedure:  The follow-up procedure at ……………..Medical Practice is as follows: 1.1 Contact Details:

Reception staff routinely verify patients’ contact details and Medicare Number when patients arrive at the practice.

1.2 Tracking and Following-up Ordered Tests, Investigations, and Referrals: GPs add a reminder prompt for an appropriate time interval when ordering clinically significant tests, investigations or referrals. The practice nurse checks the reminders on a weekly basis to detect any tests, investigations or referrals that have not had results, reports or correspondence returned, and notifies the GP. The GP initiates or delegates follow up in a timely manner of expected results, reports and correspondence that have not been received. The patient is contacted by phone or letter. The outcome of this contact is documented in the patient file and either: More time given to patient to attend for test, investigation or appointment Contact is made with the diagnostic laboratory if the patient indicates the investigations

have already been undertaken Contact is made with the specialists’ rooms if the patient indicates the appointment has

been attended If the patients refuses the test, investigation or referral, their refusal of treatment or

advice is documented in their medical file 1.3 Reviewing Of Results:

Doctors (or a delegated doctor) review the results in the inbox, select the appropriate action and, if needed, create an electronic reminder or action with an appropriate time frame (depending on urgency). If follow-up is required, the GP or a delegated staff member contacts the patient. The necessity for follow-up is documented in the patient file. The decision and extent of responsibility to follow up depends on:

The probability the patient will be harmed without follow up The degree of likely harm The burden of taking steps to avoid the risk of harm

All ‘correspondence in’ relating to a referral is checked by the GP and initialed. The GP will add results, or delegate the practice nurse to add results, as appropriate (eg foot and eye checks for diabetic patients in the annual cycle of care). If deemed necessary by the GP, the letter will be scanned by reception and added to patient file.

1.4 Notifying of Results: Patients are advised whether the practice will notify them of the results or required follow up, or whether it is their own responsibility to seek the results of their tests. Patients telephoning or presenting to reception for results should be correctly identified before being given any results or referral letter.

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1.5 Follow-Up of Clinically Significant Results/ Reports/ Correspondence:

GP phones or asks reception to phone the patient. If there is no answer, repeated attempts (at least 3) are made on different days at different times of the day. If still no contact is made, a letter is sent. Letter to be saved in ‘correspondence out’. If still no response a letter is sent by registered mail. All attempts to contact patient are made in the patient file.

1.6 Managing Recall Appointments Recall appointments should be booked in clearly as recalls. If a patient fails to attend the GP is notified by the reception staff. The GP initiates follow-up or delegates follow up in a timely manner to rebook an appointment time. Each attempt to contact the patient is noted in the patient file. Recalls are not marked as performed until the consultation has taken place, and remain on the reminder list for ongoing recall, until such a time as the practice deems that all reasonable attempts to contact the patient to come in for the consultation has been made. The level of persistence depends on the clinical significance of the recall and is made at the discretion of the health practitioner.

1.7 Informed Consent

Patients are informed through waiting room notices and patient information sheets about the recall and reminder system at the practice. Patients can elect to opt out of the system for preventive health recalls (as opposed to recalls for clinically significant results). Recall letters will contain the reason for the recall, why the recall is important, and the frequency of recalls to expect for this issue. Consent is assumed if the patient has been given the patient information sheet and has not elected to complete the ‘opt put’ request form. The consent is then documented in the patient file.

1.8 Opt Out Policy Patients can elect to opt out of recall for non urgent preventive health, as long as they have made an informed decision (eg as per the patient information sheet). This decision to be excluded from reminder recalls for non urgent or ongoing disease maintenance issues will be recorded in the patient file.

1.9 Registers:

Patient Consent will be sort before transferring patient information to national registers for preventive care ( eg ACIR, Pap Screen). Practice based registers will be developed and kept current by an appointed staff member.

2.0 Preventive Care Recalls: Patients with a specified medical condition (eg diabetes) or who are in a specific age group (eg over 75) or with specific risk factors (eg ATSI) are placed on a practice register and, subject to patient consent being granted, be subject to appropriate reminders.

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2. Sample Patient Information Sheet Name & Address of Practice

RECALL & REMINDER SYSTEM This practice uses a “Recall and Reminder” system to provide preventive care for its patients, to follow up abnormal or significant test results, to manage patients with chronic disease, and to ensure important health checks are not forgotten and are performed. This will assist the practice in ensuring that important health checks are not forgotten and are performed on time, as well as ensuring that significant results are discussed. We will use information from your health record to tell us when appropriate check-ups or tests are due. By allowing us to send you a reminder letter, you will help us to detect serious conditions early and to monitor and manage known conditions. This can significantly improve the long-term outcome for you. In some cases, the reminders can also be sent from other places, e.g. Australian Immunisation Register (ACIR), or from Pap smear Registry. Our doctors follow the guidelines for preventive care as outlined in the Royal Australian College of General Practitioners’ Guidelines for Preventive Activities in General Practice. The guidelines are in line with the recommendations of organisations such as the National Health and Medical Research Council, the National Heart Foundation and others. If you elect not to be part of our recall and reminder system, please complete the form below, and a note will be made in your file. Even when you agree to be included in the Recall and Reminder system, you should remember when you should be tested for certain conditions and should always contact your doctor to get the results of a test that has been performed. We may not always be able to reach you, especially if you have moved and the contact information on your record has not been updated. Please discuss with your doctor any concerns you have or if you wish your doctor to make clear anything to do with the Recall and Reminder system. Date …./…./…. To: Practice A I………………………………………………………………of………………………………………………………..do not wish to be part of your recall system. Please remove my name from your list. Signed…………………………………………………………………………………………..

3. Recall letter for patients unable to be contacted by telephone  (Patient Details) (date) Dear………………………………………. Results of your recent test (insert test name) have been received by your doctor. We have been unable to contact you by phone, despite making several attempts over the last few days. Please contact the Clinic on 52………… to make an appointment time with the doctor to discuss your results. Thank you Yours sincerely (Dr Details)

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4. Reminder Letter 

(Patient Details) (date) Dear………………………………………. A reminder that your repeat/ annual/ monthly/ quarterly/ half yearly………………check is now due. One of our staff will shortly be in touch with you to make an appointment. If you have had this check, test at another clinic, please let us know so we can update your records. Please contact us with any queries. Yours sincerely (Dr Details)

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5. Cleaning up the Recall Menu 

a) Adding Reminder Reasons to the Menu 

1. Open any patients file and click on clinical/ recalls

2. Click on Add

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3. Type in the new menu item and select the appropriate recall interval, OR tick the once only recall box. Click on ‘Save protocol’. This will make this recall reason available for all patients. DO NOT click on the Save button as this would add a recall for the patient whose record you presently have open.

4. Add other recall reasons as appropriate, remembering to click on the Save protocol

button after each new recall reason.

5. This reminder reason has now been added to the menu

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b) Deleting Reminder Reasons from the Menu 

1. Following step 1 & 2 as per previous, highlight the menu item you wish to delete

with a sustained left mouse click. While the mouse is held, press the delete button.

2. Click Yes

3. The menu item has been deleted

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c) Linking Current Reminders with a New Reminder Menu Protocol 

Once you have deleted unwanted recall menu items and created any needed new menu items, you will need to link actual current reminders in patient files with the appropriate new recall protocol.

1. With MD closed on all desktops, go to HCN maintenance. Select Maintenance Tasks and Medical Director in the left-hand menu. Now click on ‘Merge Search Lists’.

 

2. Check that Recall List is selected

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3. The items in the left are current active reminders on patient files. The items on the right are the range of recall reasons you have embedded in your recall system. Select the item on the left followed by the item on the right that you want it linked with.

4. You can see the current reminder item of ‘Visit the Moon’ is now missing from the left menu and will be picked up by a search for ‘Clean the toenails’.

5. Continue this

process until all the obsolete menu items on the left are linked with an appropriate item on the right.

 

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6. Adding a Recall to a Patient File 

1. Open one of the patient’s records. From the Clinical menu select Recall and the Recall items window is displayed. Please Note: Clicking on the Current button will display the Recalls for the next 30 days. Clicking on the Show all button will display all stored recalls.

2. Click on the Add button.

3. From the Recall list, scroll down to the reminder reason you wish to select and select it by clicking on it once.

4. Select an appropriate interval OR click on the Once only recall box. Click on Save.

5. Click on Close when back in the Recall items window.

6. On returning to your Progress Notes the recall will have been automatically added to the

Actions window (unless Progress Notes have been disabled through one of the Options choices).

Apart from the patient screen as above, Recalls are also generated from:

Immunisation screen Pap Smear screen Health Assessments (patients over 65). Clinical – Health Assessment

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Pathology results when checking the holding file. Tools – Check Investigation Results – View – Mark for Routine Recall

Progress Notes – Review – Select Date – Add to recall database Search – Asthma – Recall Search – Diabetes – Add Recall Search – Chicken Pox – Recall (MD2 only)

Mail merge letters can be generated from: Search – Databases (MD3 Search > Patients…) Search – Asthma Search – Immunisations Search – Pap Smears Search – Recalls Search – Chicken Pox ‘At Risk’ (MD2 only) Search – Influenza ‘At Risk’ Search – Pneumovax ‘At Risk’ Files – Outstanding Actions (MD3 Clinical > Outstanding actions)

7. Removing a Recall (So it is removed from recall searches)  During a consultation you may notice the Recall telephone “bouncing” on the screen – this simply means a recall is due within the next 30 days. You may be therefore be in the position to deal with it now. Once the recall has been dealt with you will need to remove the recall so that it will not be included in future recall searches resulting in the patient being notified of it again. 1. Click on the Recall due button.

2. Click on the Show all button of the Recall items window. 3. Click on Recall Item you wish to remove to highlight it and then click on Remove 4. Click on the Close button.

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8. Creating Recall Search Lists 

1. From the front page of MD select Search / Recalls.

2. Select a search interval – eg 1 week, 1 month

3. Click on the Select all reasons checkbox. Click once on any of the highlighted recalls (such as PAP SMEAR) you don’t want – this will remove them from the recall list box. Then click OK.

4. A list of patients fitting the criteria will be displayed.

5. If you don’t wish to include a patient in the printed list click on the patient’s name and then press the delete key on the keyboard.

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6. By clicking Yes you are able to remove the patient from the recall list as well as the list on the screen.

7. If you wish to print the list and phone patients for recall you can do so.

8. Once the list is printed, click on Cancel so that the recalls remain valid – The doctor then removes the recall during the consultation when the patient returns. This means the “ringing” recall button will appear in the patient’s window when a recall is due within 30 days.

9. If you wish to send out recall letters, proceed by clicking on the Mail Merge button at the bottom of the screen.

10. Select you recall template and click on Open.

11. Once printing is complete close the Recall mail merge letter and then close the Recall list

and Letter Writer to return to the main screen of Medical Director.