From primary care to specialized cancer care, from hospital to long-term care, from patients’ electronic medical records to clients receiving information about a new medication, providing patient-centered care is not one person’s responsibility. Effective patient care involves all care providers working in true partnership with patients and their families. It particularly involves the effective transfer of complex information. In its annual Canadian Health Accreditation report “Safety in Canadian health care organizations: A focus on transitions in care and Required Organizational Practices“, Accreditation Canada turns the lens on care transitions – handovers at shift changes, patient transfers, discharges and referrals – in Canadian health care organizations and finds opportunities for improvement.
If your family member is in a long-term care home or hospital, would you expect specific steps to be taken to coordinate services and effectively transfer information? Of course you would. Would you expect processes and strategies to be in place at each location where care is provided to safely administer medications and to prevent falls? Of course. Care transitions are critical points in the care system during which the communication and/or transfer of information is vulnerable. A breakdown in communication creates safety risks for patients and an associated increase in costs to the health care system. Poorly coordinated care has a significant impact on patients and their families.
In 2012, 277 health care organizations across the country were assessed by Accreditation Canada surveyors, including physicians, nurses, pharmacists and therapists. Results indicate that participating health care organizations achieved a high level of compliance with standards related to coordinating services across the continuum of care. However, there was a drop in compliance with follow-up to evaluate the effectiveness of those transitions. This revealed only 73% compliance across the country, highlighting a key opportunity for improvement in the health care system. While these rates of compliance indicate that collaboration is in place and that providers work together for client placement, the low rate of compliance—with use of follow-up contacts to evaluate transitions and improve services—is a concern and is a key opportunity for improvement in care transitions.
Considering how many transitions occur daily, care transitions are critical and vulnerable points in the care system during which the communication/transfer of information may be less than optimal. Breakdowns at care transitions create safety risks for clients and increase costs to the health care system. One way to improve this communication is through an effective e-referral solution.
The presence of an intelligent electronic referral (e-referral) system can help ensure that this critical information flow occurs in a timely way. E-referral systems can incorporate agreed upon guidelines for referrals and transitions that prevent unnecessary ones and assure that consultants and PCPs get the information they need to appropriately progress the patients’ care plan.
Automated patient flow practices such as eReferral delivers the critical change needed to achieve real benefits for patients, their families, overworked front-line workers, and health systems. Our recent white paper, The Healthcare Executive’s Guide to Streamlining Patient Flow for Successful Patient Outcomes, looks at current referral practice and how the eReferral solution dramatically improves patient flow to: Reduce cost; Increase productivity; Align with clinicians; and Maximize ROI.
When all members of a patient’s care team, no matter what location they are at, have the right patient medical information available at the right time and place they need it, then these professionals can provide better, timelier, and more cost-effective care, improving that patient’s experience and maintaining system economies simultaneously with ensuring the safety of your care transitions.
High-quality referrals and transitions depend upon every provider responsible for the patients’ care having the information they need when they need it. The requisite information of course includes essential data about the patient and their treatment plan. The essential information should also include the test results needed by the consulting specialist to complete their consultation. Referring patients without test results deemed necessary for an adequate consultation is a common reason that referrals are refused. This requires that duplicate testing must be done or consultations take multiple visits. Which tests are necessary may well vary among physicians in a given specialty, so they need to be discussed as part of the agreement process.
To learn more about ways to improve your eReferral process download The Healthcare Executive’s Guide to Accelerating the Value of Health Information Exchanges with Resource Matching and Intelligent eReferral and The Healthcare Executive’s Guide to Streamlining Patient Flow for Successful Patient Outcomes.