The Evolution of a Regional Referral and Acknowledgment Form

IMPROVING ACCESS TO SPECIALIST CARE:
The Evolution of a Regional Referral and Acknowledgment Form
Ken Gin, MD, Joy Russell, MD, Moe Baloo, MHA
Background/Problem
Evaluation Results and Summary
The Vancouver Division of Family Practice recently identified access to cardiologists and cardiology services as a key priority area in the day-to-day practice of
family medicine. In particular, challenges with the referral process was noted as it relates to the wide array of specialists, diagnostic testing, clinic locations,
referral forms, wait times for an appointment, and acknowledgment of referrals.
Phase 1 - Over the trial 3 month pilot period:
• 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 VCH cardiology ambulatory clinic
Survey Results of Family Physicians Reporting Challenges with the Referral Process
Phase 2 – Based on pre-and post survey questions:
•
•
•
Percentage of Family Physicians
reporting an improvement in the
the referral process after using
referral form:
All family physicians reported an increased knowledge of cardiology services
38% of specialists said referrals contained more relevant information compared to
6% prior to using the form
Overall, 67% of family physicians and 62% of specialists said the referral process
had improved after using the form
Percentage of Specialists
reporting an improvement in
in the referral process after
using the referral form:
“I have hundreds of forms in my referral folder, it can get unwieldy. Sometimes I spend a lot of
time looking for the correct form”.
“Time consuming and hard to find the correct form”
“hard to keep track of which forms for which office/doctor”
Proposed Solution
Over a period of 18 months with input from over 20 specialists, 30 family physicians, patients, MOA’s, and administrative leaders, a comprehensive
regional referral form was developed that includes over 30 outpatient cardiology clinics from throughout VCH. In addition, mechanisms to ensure the
appropriate inclusion of relevant information as well as a process to ensure timely acknowledgment of the referral has been embedded in the form.
Challenges & Next Steps
CARDIOLOGY REFERRAL
REFERRING PROVIDER:
PATIENT INFORMATION
Name:
Name:
Date:
PHN:
DOB: (dd/mmm/yy)
SPECIALTY CLINICS
St. Paul’s
VGH
Richmond
Lion’s Gate
Atrial Fibrillation (AFC)
Heart Failure
Cardiac Rehabilitation
Healthy Heart - Prevention/Lipid
Smoking Cessation
Pulmonary Hypertension
Heart Rhythm Device (HRD)
Heart Rhythm Management (HRMC)
BC Inherited Arrhythmia (BCIAP)
• 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?
Pacific Adult Congenital Heart (PACH)
Heritable Aortopathies (HAC)
Cardiac Obstetrics (COB)
Cardiac Oncology
Women’s Heart Health
Urgent Care
Pre-Heart Transplant
Sports Cardilogy
Rapid Access Chest Pain Clinic
We wish to acknowledge and thank the Cardiology-Family Medicine Working Group for their time and contribution to this initiative: Drs. Ken Gin, Andy Ignaszewski, Victor Huckell, Carolyn Taylor, Robert Boone, Graham Wong, Robert Moss, PK Lee, Jonathan Tang, Simone Cowan, Joy Russell, Margo Sweeny, Carol Story, Angela Nguan, Sophia Chong, Margaret Tran,
Annemarie Kaan, Suzanne, Nixon, Jo-Anne Thomas, Kandie Parsons, Candy Chen, Sherry Mark, Sue Macdonald, Sheila Pither, Helen Roberts, and Margot Wilson . We also wish to thank Drs. Joanne Yang, Sean Virani, John Vyselaar, Andrew Jakubowski, Yong Dong You, Kevin McLeod, Andrew Krahn, Shanta Chakrabarti, Krishnan, Ramanathan, Sammy Chan,
John Jue, Nathan Brunner, Marla Keiss, Milan Khara, and Gordon Francis for their contributions. Thanks also to administrative and operational leaders, Bethina Abrahams, Michele Perry-Arnesen, Faisal Aziz, Marla Steinberg, Julie Carleton, Amanda Harvey, Karen Lecomte, Jackie Forman, George Lee, Cindy Lawlor, as well as assistants Danilyn Rarama, Debbie
Howe, and Bonnie Kong. Lastly, a very special thanks to Anne Pearall at PHC Forms Support.