Dialogue Volume 14 Issue 2 2018 - Page 14

FEATURE what can be expected of any individual physi- cian due, in part, to the nature of their practice and the health system resources available to them,” said Dr. Copps. The draft makes a distinction between coverage for patient care and coverage for test results. While having a plan in place is suf- ficient to coordinate care for patients outside of regular operating hours, critical test results need around the clock coverage. Coverage arrangements could include participating in an after-hours call group, telephone triage, or making specific on-call arrangements with other physicians or practices. This is simply a refinement of the current expectation found in the Test Results Management policy. “We heard through the preliminary consulta- tion feedback that laboratories often experience great difficulty communicating critical test re- sults to physicians, even if they have provided coverage information,” said Dr. Copps. This, of course, puts patients at great risk, as critical test results could be a matter of life and death and may require patients to seek out immedi- ate intervention, she said. The draft also requires that physicians have an office telephone that is answered and/or a voicemail system that allows messages to be left during operating hours and outside operating hours. “Good communication and collaboration are fundamental components of high quality care, but are not possible if patients and health-care providers are unable to contact physicians,” said Dr. Copps. Managing Tests This draft policy sets out the College’s expectations for physi- cians regarding the management of all types of tests. This draft is a revision of the College’s cur- rent Test Results Management policy. Managing tests effectively is an essential part of continuity of care. It includes having a robust test management system, ordering and tracking 14 DIALOGUE ISSUE 2, 2018 tests, following up with patients once test results are known, communicating and collaborating with other health-care providers, and providing opportunities for patient engagement. This draft covers a number of expectations about different aspects of test management, including addressing the ‘No News is Good News’ approach that many physicians adopt in regard to test result management. ‘No news is good news’ approaches are permitted in the draft policy; however, there are a number of caveats to this approach, said Dr. David Rouselle, a Newmarket obstetrician, who is on the working group. “Ultimately, we landed on the expecta- tion that those physicians who do want to use a ‘no news is good news’ strategy must be confident that their test result management system is sufficiently robust to ensure that no test results will be missed and that no news really does mean good news. That is, that the absence of a call back to the patient means that the test result was received, reviewed and a determination was made that no follow-up was required,” said Dr. Rouselle. But, he added, that even with a robust test results management system, a ‘no news is good news’ strategy may not always be appropriate. Physicians must use their professional judgment to determine when a ‘no news is good news’ strategy can be used. This could be influenced, for example, by the nature of the test that was ordered, the patient’s current health status, the patient’s anxiety about the test and the signifi- cance or implications of the potential result. Physicians must inform patients as to wheth- er they are using a ‘no news is good news’ strategy and must tell patients that they have the option to personally contact the physician’s office for the test result if they prefer to do so. The draft policy provides guidance to physi- cians on how to involve their patients in their own care related to tests and te