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.
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