A great comprehensive piece by Dr Tim from KI on MyHR.
A great comprehensive piece by Dr Tim from KI on MyHR.
The man appointed by Malcolm Turnbull to transform the Commonwealth’s digital public services has said if he was Australian he would probably opt out of the Government’s controversial online health database.
Partridge Street General Practice is all about professional, comprehensive, and empowering General Practice care by our GPs. When we refer our valued patients for treatment elsewhere we promote the same high standards, values, and communication that we provide. A letter, referral, or phone call is just part of the standard Partridge Street General Practice service – it’s good clinical handover. Dr Nick Tellis recently collaborated with some excellent GPs in writing an article for the Medical Journal of Australia’s online Insight Blog on ways to improve communication during these times and stressing the importance of better clinical handover. It’s another one of the ways Partridge Street General Practice provides Better Healthcare for our valued patients. Read on.
This is the third article in a monthly series from members of the GPs Down Under (GPDU) Facebook group, a not-for-profit GP community-led group that is based on GP-led learning, peer support and GP advocacy and was originally published at the Medical Journal of Australia (MJA) Insight Blog here.
“PASSING the baton” describes what health care professionals try to achieve as care of patients is transferred between providers in our complex health care systems. The topic of safe and effective clinical handover comes up repeatedly in discussions on GPDU.
It is apparent that the impacts from delayed or poor clinical handover on patient care across the country are significant, under-reported, and have a profoundly negative effect on the care patients receive.
Dropping the baton
First-hand accounts of treatment delays, duplication of testing, medication errors, and unplanned readmissions are frequently discussed by GPs. Recent clinical case discussions have included a patient in palliative care being transferred to a hospice on a Friday afternoon with no clinical handover, and a 3-month delay in the completion of a discharge summary for a truck driver who was admitted with a myocardial function.
The safety concerns related to poor clinical handover are not new: it’s a problem the health care industry and doctors as a profession have been grappling with for decades. Poor clinical handovers are wasteful of limited resources. How can we improve patient outcomes and “drop the baton” less often?
Rules of the game
The National Safety and Quality Health Service Standards (NSQHS) and the Australian Commission on Safety and Quality in Health Care (ACSQHC) define clinical handover as; “the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group”. Appropriate clinical handover is a requirement of the NSQHS. The ACSQHC notes the importance of “transition of care” that “ends only when the patient is received into the next clinical setting”. The Australian Council on Healthcare Standards EQuIP National Standard 12, in particular, specifies the planned provision of transfer information, including results of investigations.
Breakdown in the transfer of clinical information has been identified as one of the most important contributing factors in serious adverse events, and is a major preventable cause of patient harm.
Why is clinical handover from hospitals to GPs done so inconsistently for patients transitioning from our major private and public institutions? The benefits of passing the baton smoothly are clear. It’s time to coach the team to get it right.
Timing is everything
Health services continue to debate the appropriate timeframe for communicating with the GP who is continuing the patient’s care. Timeliness of clinical handover is a topic that comes up frequently. Hospital targets for transfer of care communications vary widely. A recent discussion on GPDU identified several targets within one small geographical area, ranging from “at the point of discharge”, “48 hours after discharge” and “5 days after discharge”.
The reality is that few patients leave hospital with an effective clinical handover. Some will be received within the hospital’s current targets; however, many clinical handovers are not received for weeks, months or, as one post highlighted, years after the patient care is transferred. Some never occur.
Many GPs are asking whether these targets are consistent, appropriate, acceptable or safe. A robust discussion took place after GPs were approached to complete a survey that included a question asking what conditions should warrant a discharge summary on discharge, and what the acceptable timeframe for receiving a discharge summary should be.
The overwhelming consensus was that the gold standard should be clinical handover on discharge for all patients. Many were frustrated that this question even needed to be asked. Some GPDU members wondered whether this was a trick question aimed at moving the goalposts further away from quality patient care.
Services promoting clinical handover to GPs on discharge were highlighted. The Sunshine Coast Hospital and Health Service was identified as a provider that was actively trying to effect positive change. They received plaudits from the wider GP community simply by having a discharge summary management policy specifying complete discharge summaries available at the time of patient discharge.
It is well known in GP circles that starting late ensures that you will run late all day. Timely discharge summaries aren’t late. Timing is everything when you want to be a frontrunner.
Don’t fumble the handover
The consensus among GPs is that well timed, efficient, effective and safe clinical handover, at or before the point of transition of care is essential. Alternative strategies risk adverse outcomes. Clinical handover must be a standardised process between clinicians.
Returning to the athletics track, we can see a clear difference between a handover, a throw, and a drop. Highly trained athletes accept nothing less than a smooth handover – nor should highly trained clinicians. Delegating the handover to non-clinicians, including nurses and medical students, is not good enough. Supervision and ongoing coaching of clinicians is vital.
The baton is passed between people not machines
Imagine the difference electronic systems could make to this smooth handover. Sadly, this smooth electronic handover exists only in the imagination.
In the real world, GPs are grappling with being thrown links to hospital electronic records through systems such as “The Viewer”. Investigations are likely to be uploaded (after a delay) to MyHealthRecord. These are raw data, unfiltered and disorganised, and more of a throw than a handover. Being thrown raw data and being expected to catch them in this way is akin to a hospital doctor being given the login to the GP clinic’s patient management system and being expected to extrapolate a referral.
Personal bests are set; medals are won
The late Sir Roger Bannister ran the 4-minute mile and reset the expectations for all that followed him. GPs and their discussions can highlight outstanding clinical handovers and applaud initiatives and hospitals that are doing it right. Feedback and constructive criticism can be passed back to hospitals that are raising the bar. Medal-winning performances show the possible and provide a model for future improvement. GPs are uniquely placed to spot the talent and report the score widely and rapidly.
Eyes on the prize: what’s the next goal?
If we can normalise the clinical handover to young GPs who are the future of general practice, it will encourage them to demand it of their hospitals.
Hospitals are incredible places, but the aim is for patients to return home to their communities and trusted GPs. They come home. Their GPs are waiting, willing and able. We can do better, and we will. We extend an open hand to our amazing hospitals. Pass us the baton – we won’t drop it.
Dr Katrina McLean is a Gold Coast-based GP, Assistant Professor in the School of Medicine and Health Sciences at Bond University, and a GPDU administrator.
Dr Michael Rice is past-president of the Rural Doctors Association of Queensland, an educator of students and registrars, a long term resident and rural GP in Beaudesert. He’s a keen user of social media.
Contact Dr Nick Tellis at firstname.lastname@example.org or 0882953200 if You are a Great GP and want a Better Place to practice great medicine!
We’ve written about the Patient Controlled Electronic Health Record (PCEHR or MyHealthRecord) before – you can have a look at the links below.
Today we’re going to talk about how NOT to have a MyHealthRecord. Perhaps you don’t think it’s private, perhaps you’re opposed to it for some reason. Perhaps you just don’t want one. Read on.
The Australian Government is expanding My Health Record for all Australians in 2018.
By the end of 2018, a My Health Record will be created for every Australian unless they choose not to have one.
If you decide that you don’t want a My Health Record created on your behalf, you will have the opportunity to tell us during a three-month period.
This period will run from 16 July to 15 October 2018. It’s not possible to opt out of having a My Health Record before this period starts on 16 July 2018.
Want to be part of the Partridge Street General Practice team? Contact Dr Nick Tellis at email@example.com or 0882953200
If you are an Australian or a New Zealand GP looking for peer support, advocacy, or learning, GPDU (GPs Down Under) is THE place for you on Facebook!
When you apply to join, this is the message you will receive – have your information ready and await a message from your friendly GPDU administrators on Facebook Messenger.
Thank you for for the information provided with your request to join GPDU, Australia & New Zealand’s closed Facebook group for learning, peer support and advocacy.
We consider GPDU to be a ‘National Park’, open to all Australian & New Zealand primary care doctors.
We don’t mind if you are RACGP, ACRRM, RNZCGP, VR or non-VR, full-time or part time, urban or rural, trainee or Fellow. We are however passionate that we do our utmost best to ensure that members are registered with AHPRA or the NZ medical board, and working in primary care.
🔸Can you please provide a screenshot (or photo) or your RACGP dashboard (visible when logged in to the RACGP website. ACRRM RRMEO page, or RNZCGP membership profile.
If not already submitted, can you also please provide:
🔹A screenshot/photo of your AHPRA registration certificate (or link to webpage)
🔹Information linking you to your practice, this may include a copy of a business card with you name and the practice address, training confirmation letter or link to a website with your profile and name.
We appreciate that this may seem like a lot to ask and thank you for your assistance in providing the information requested in a timely manner. Please be aware that the GPDU admin team are all busy GPs who take on the admin role on a voluntary basis.
Any concerns/questions, or if you are battling with technology and struggling to figure out how to do all of this please let us know. We are more than happy to help out.
Thank you – we look forward to having you on board soon!
When you get the message from admin, send three screenshots back! RACGP/ACRRM/NZ college info, AHPRA info, practice info with you in it and You. Are. In!
We look forward to seeing your application, your Facebook Messenger replies with the required information, and finally and most importantly, your ongoing and valuable contributions to the National Park of learning, peer support, and advocacy that is GPDU!
Doctors are people too. Is this a controversial statement? I’m going to go further and say doctors are people first. I bring this up because some doctors are amazing but they are still only human. There’s a special respect from me for our rural doctors including rural generalist GPs. To me, they are Superhuman! I look at what I do now, and what I used to do as a rural doctor (within 30km of a major Australian city), and, to quote a popular film it’s not the same game. It may not even be the same sport.
I’ll move to some other popular culture. A guilty secret of mine is that I like comics. One series I really liked (and beware this is a NSFW comic and not for children) is Irredeemable. It’s the story of an alien superman (The Plutonian) who becomes a superhero on Earth. He’s super resilent, can fly, has superhuman endurance…you know, those usual rural generalist abilities. The series opens with a family running for their lives. Heat beams target them. Their house is reduced to rubble. Spoiler Alert – they die. Hovering in midair over their bodies is The Plutonian. What happened?
Prior to the above events, the Plutonian was doing his thing, saving people. It’s what he did. Day in, day out, with never a day of rest. He stops a nuclear bomb going off in a packed sports stadium. The crowd goes wild. He stands there, letting his adrenaline drop down. One voice comes to his ears amongst the adulation of the crowd.
‘What a poser’, or words to that effect. Only a few words, only one person, and buried in a sea of praise. But they were enough. They were too much. Superhumans are human too. Perhaps they are human first too? He snaps and flies off.
I think 14 doctors committed suicide in the last 12 months. I could be wrong about this number. I’m not wrong when I suspect the number that had contemplated suicide was probably much higher. I don’t know the answer but being kind is a good start. Please, be kind. That is all.
I would love to hear other views on this. We are all professionals or patients or both and we can always improve. Let me know here on the blog (or on our website) – or, if you’re a GP, on the fantastic GPDU FB Group – where GPs are invited to a festival of education and collegiality (#FOAMed – #GPDU18) May 30 – June 1!
(Here’s some we made earlier)
We look forward to seeing you soon!
We’ve just celebrated the Chinese New Year – the Year of the Dog. People born in Dog years display loyalty and honesty amongst many other good qualities. However it is said that they can also be critical – maybe overly so. Segueing to another Chinese concept, we meet Qi, the vital life force that flows through the body. Let’s put these together.
A wise man once told me that the three pillars (the vital life force) of general practice are quality, service, and finance. All three of these come together in the form of the Practice Incentive Payments (PIP) scheme. You can read about this here but in summary Accredited General Practices are paid amounts of money for reaching certain quality measures. These include planning the management of a proportion of patients with diabetes and asthma, and ensuring women are screened for cervical cancer. There are also Incentive Payments for managing aged care and quality in prescribing.
These payments were due for a change on May 1st 2018. Were they promoting the vital life force of General Practice, were they tick box exercises for busy GPs, or were they overly critical of General Practice, not focusing on true quality? Enter QI – Quality Improvement. Rather than Qi, QI may be an altogether different beast.
The Department of Health has confirmed that the Practice Incentive Program Quality Improvement Incentive will now occur from 1 May 2019.
From their press release:
The Practice Incentive Program (PIP) has been a key driver in quality care in the general practice sector and the PIP QI Incentive will continue to build on this important work, further strengthening quality improvement in primary health care. The additional 12 months will enable the Department, with the support and advice from PIPAG, to ensure that any implementation issues are identified and addressed and that general practices have adequate opportunity to prepare. It will also allow the Department to continue to consult with stakeholders on refining the design of the PIP QI Incentive.
The changed time frame will mean that the following five incentives which were to cease on 1 May 2018, will now continue through to 30 April 2019.
The five incentives are:
Quality Prescribing Incentive
Cervical Screening Incentive
General Practitioner Aged Care Access Incentive
The six PIP Incentives that continue to remain unchanged are:
After Hours Incentive
Rural Loading Incentive
Indigenous Health Incentive
Procedural General Practitioner Payment
What next? Will the new QI beast be reflective of quality in General Practice? Will the measures align with what we as General Practitioners believe is high quality Great General Practice care? Or will it aptly be launched in the Chinese Year of the Pig in 2019?
For what it’s worth, here are my measurements of quality, service, and finance in General Practice – the Qi of GP:
I would love to hear other views on this. We are all professionals or patients or both and we can always improve. Let me know here on the blog (or on our website) – or, if you’re a GP, on the fantastic GPDU FB Group – where GPs are invited to a festival of education and collegiality (#FOAMed – #GPDU18) May 30 – June 1! My last quality ltip – for personally better Qi – is below!
(Here’s some we made earlier)
We look forward to seeing you soon!
We never want to lose the doctor patient relationship in General Practice. It’s the most valuable part (and the most rewarding part) of our vocation and service as GPs. If we can have technology in the background rather than in the way, I think we can strengthen this. Facebook is one example.
Here’s another. Step one: buy a gaming keyboard. Step two: Program some macros. Step three: Spend more time with Our Valued Patients and less with our technology and medical software!
Here’s me cutting my login time to zero. It’s one small step for Dr Nick….
What do you think?. Is this part of the future? Too soon?
Not what you want? Let me know. In the meantime, we’re all still here for you at Partridge Street General Practice, face to face, IRL 😎
Your GPs at Partridge Street General Practice
Not so long ago it was quite hard to contact Your GP. You had to phone the practice to make an appointment (some waiting), come to the practice (more waiting), and then sit in the waiting room (more waiting). We live in an instant world and we seek convenience. How can technology give you more of what you want while Your GP gives you more of what you need? Try this!
More and more of our valued patients are choosing to book online but You can still call Partridge Street General Practice and we’re always happy to talk to you. You can also email us or contact us here for non-urgent inquiries, remembering that email is not a secure form of communication.
Imagine if you could ask some simple questions of Your GP, without waiting on the phone or sitting in the waiting room. Simple questions that have been asked of me in the past:
When should I come in to see you next?
I lost my script, what do I do?
I was discharged from hospital, what next?
We never want to lose the doctor patient relationship in General Practice. It’s the most valuable part (and the most rewarding part) of our vocation and service as GPs. If we can add to it, by improving communication before a face to face consult, I think we can strengthen this. We have a trial project with free access to a secure app where you can speak with me (not Facebook!). It’s not for urgent consultations! It’s free to sign up – you only pay if you use it.
Have a look here!
What do you think – tell me here (or on the app!) about what you think. Is this part of the future? Too soon? Not what you want? Let me know. In the meantime, we’re all still here for you at Partridge Street General Practice, face to face, IRL 😎
Your GPs at Partridge Street General Practice
How many of you know what Your GP has done professionally? Find out – and ask away!
Click away here!
Remember, all of our GPs here at Partridge Street General Practice are Here to Help You!
You can see any of our Great GPs right here: