The Hospital
We are an urban ED with around 70,000 visits per year; ~20% over 65.
The Need
We used to receive verbal feedback from family doctors that they never knew when their patients had been in the ED – or what happened to them when there. They had no idea of what investigations had been done or what changes to medication had been made. Patients, especially older ones, had difficulty communicating what the outcomes were or what they were told to do, other than “follow up with your family doctor!”
The Improvement
We implemented a policy that ALL charts for patients over the age of 65 be faxed to the family doctor by the clerical staff when the chart is being discharged; and that ALL patients leave the department with a copy of their chart and printouts of any results that were back (labs, xrays, etc.)
Metrics: All charts are stamped “faxed” at the time (medical records requirement). We do periodic audits as part of performance review of clerical performance and feed that back to the individual ward clerks.
Strategies for success: Patients/families are told by the registration staff when they register that they will receive a copy of the chart. So it becomes a patient expectation and that certainly drives RN/MD behaviour. It is such a standard part of ED process that RNs often pursue patients to ensure they have their discharge paperwork. Like many senior-friendly practices it is also good for the general population and has mostly been extended to them.
Cost: minimal – the process of auto-faxing around 70 charts a day probably consumes close to an hour of clerical time so there is a small HR cost.
Outcomes
Admittedly the quality of the “written” faxed record can be low – or sometimes unclear. At a minimum, family physicians are aware that their patient has been in the ED. And patients have a paper record of their visit – which is especially helpful for older patients with cognitive impairment.
For more information, contact: Nana.Asomaning@sinaihealthsystem.ca
