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
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