Dialogue Volume 14 Issue 2 2018 - Page 15

FEATURE and to follow-up if they continue to feel unwell. Physicians should also be proactive in informing patients of the significance of the test ordered, the importance of getting the test done, having it done in a timely manner, and complying with requisition instructions. Transitions in Care This draft policy sets out the College’s expectations of physi- cians when patient care or an element of patient care is transferred between physicians, or between physicians and other health-care providers. In particular, this draft policy sets out expectations in relation to keeping pa- tients informed about who is responsible for their care in hospital and during the referral and consultation process, managing patient handovers in hospital, hospital discharges, and the referral and consultation process. Research reveals that only a minority of primary care physicians report always getting the information they need from specialists, and fewer say this information is shared in a timely manner. On the other hand, specialists report that, too often, referrals lack basic information about the reason for the referral. Our preliminary consultation feedback echoed these concerns. Stakeholders identified instances where referrals or patient information were lost, where referrals went unanswered, or where there was poor information sharing between physicians, said Dr. Peeter Poldre, a consultant-hematologist in Toronto and a member of the working group. “In regards to improving the coordination of the consultation and referral process, we’re ask- ing referring doctors to be mindful of whether the consultant physician is accepting patients and that it is within the consultant’s scope,” said Dr. Poldre. “We are then asking consulting doctors to acknowledge referral requests in a timely man- ner, urgently if necessary, but no later than 14 days after the referral was made. We want to avoid situations where consultation requests go unanswered or are simply declined after a long wait. Those kinds of delays can negatively impact patient safety,” he said. And to help consultants move forward, the working group has refined the expectations in terms of identifying what kind of information should be included in a referral such as the rea- sons for the consultation request, as well as any information the referring physician is seeking and/or questions they would like answered. Stakeholders who participated in the pre- liminary consultation also worried that a lack of clarity regarding who is responsible for booking consultation appointments (i.e., the patient, the consultant, or referring physician) may cause breakdowns in continuity of care. “There’s a lot of confusion around who is responsible for communicating appointment information with patients and we’ve heard from doctors and patients who have experi- enced frustration in this regard. We’ve sought to bring some clarity to this process while leaving room for referring and consulting physicians to figure out what works best in the circumstances,” said Dr. Poldre. During the preliminary consultation, stake- holders also expressed concern about discharged patients who do not understand their care needs or do not understand when and from whom to seek out care if complications arise. The literature also included recommendations in this regard, setting out suggested information to share with patients prior to discharge. Prior to discharging a patient from hospital, the draft states that physicians must ensure that they or a member of the health-care team has a discussion with the patient and/or substitute decision-maker about such matters as risks or complications and when action should be taken. The draft suggests that reasonable steps be taken to involve the patient’s family, if the patient wishes. There may be instances where the patient and/or substitute decision-maker would benefit from having elements of the discharge ISSUE 2, 2018 DIALOGUE 15