CALGARY – In a 92-page report, the Health Quality Council of Alberta is urging that steps be taken to improve communication among the province’s doctors, after analyzing the case of a testicular cancer patient who died in 2012.
The patient suffered from multiple communication gaps among his caregivers, including a three-month wait for a consultation to see a surgeon without any notifications, and the failure of a diagnostic imaging clinic to inform a referring physician about the results of a CT scan.
Greg Price, 31, died on May 19, 2012, three days after surgery to remove a cancerous testicle. He had experienced extensive delays and breaks in communication that most likely led to his sudden and unexpected death.
“Greg died prematurely. We believe he died prematurely because of multiple gaps and failures in the so called system of healthcare in Alberta,” Greg’s father David Price (pictured) said at a press conference. He and the Health Quality Council believe that ‘continuity of care’ breakdowns are not uncommon, and that changes should be made to improve the quality of care in Alberta.
The Health Quality Council’s report, called Continuity of Patient Care Study, makes 13 detailed recommendations. They include:
1. That Alberta Health and Alberta Health Services should strongly consider making additional investments in the provincial electronic health record and e-referral system to standardize workflow processes for all specialized healthcare services so that the following functionality is available for all patients and practitioners in Alberta:
• Electronic referrals confirmed as ‘received’ by the service provider.
• Management of appointment scheduling including booking confirmation and patient notification.
• Report generation and transmission back to the referring provider.
• Confirmation that the patient has completed a followup appointment with the referring provider.
• Notification to the referring provider about referrals that are incomplete, delayed, or denied when submitted to the service provider.
• Notification to the referring provider about known or projected waiting times for tests, consultations, or procedures that are outside specified limits.
• Notification to the referring provider and the patient about important processes (referral, appointment scheduling, patient notification, appointment completion, patient followup) that were not completed successfully according to the scheduled completion time.
• A patient portal for viewing:
• When the key steps in the referral, appointment time, and report generation process for specialist consultation, special diagnostic imaging studies, and procedures have been successfully completed and notifications when they have not.
• Appropriate contact information for patients when they detect a problem with the special health service, referral, appointment booking, or follow-up procedures.
• Lab results, DI reports, pathology reports, procedure findings, hospital discharge summaries, other diagnostic information (e.g., EKG, echocardiograms, pulmonary function tests).
When a reliable electronic referral system is developed and functioning, the net benefit to Albertans will not be realized until all healthcare providers are using the system to manage the referral and follow-up processes for patients who require specialized healthcare services.
Given that, Alberta Health will need to work with Alberta’s healthcare providers to ensure that when the system is operational and reliable, it becomes the only accepted approach for managing patients who require these services.
2. The College of Physicians & Surgeons of Alberta and other relevant healthcare colleges should amend their Standards of Practice, and Alberta Health Services should amend its policies and procedures, related to coordination and provision of services. In so doing, healthcare professionals and clinics that provide specialist consultation, advanced diagnostic imaging studies, or semi-invasive and invasive procedures would confirm completion of those studies, services, or procedures and be required to track critical process steps (transactions) between a referring provider and a service provider such that both know and have documented in a patient record that the following steps have been completed:
• A request for service has been sent and received.
• A specific appointment date and time for the service has been made.
• The requesting provider and the patient have been notified of the appointment details (and the patient has accepted the appointment).
• The report of findings has been successfully sent to (and received by) the requesting provider. This will only be possible when there is a complete provider registry that is continuously maintained and updated; this is particularly essential when service providers have a critically important result that needs to be communicated urgently to the requesting provider who is therefore responsible for managing the result for the patient.
3. The Alberta Society of Radiologists (ASR) in collaboration with Alberta Health Services (AHS) and the College of Physicians & Surgeons of Alberta (CPSA) develop policy and procedures that would support radiologists to expedite the care of a patient whom they find has a time-sensitive health condition by:
• Directly ordering the next logical DI test if one is required.
• Directly referring a patient who has a time-sensitive health condition to a clinical service when it is obvious the patient requires that expertise to move to the next level of care. This should be accompanied by a discussion with the patient and notification to the primary care physician (or the healthcare provider who requested the initial diagnostic test) about what actions the radiologist has taken on behalf of the patient.
The ASR, AHS, and the CPSA should consider developing parameters (criteria) that would assist clinicians to properly identify conditions and circumstances that could be considered ‘time sensitive’.
4. Alberta Health Services revise the current criteria for prioritizing outpatient CT scans to take into account patients with time-sensitive health conditions who do not yet have a confirmed diagnosis of malignancy. Consideration should also be given to reviewing criteria for MRI scans and PET scans to ensure that criteria for these outpatient studies are aligned and consistent with those for CT scans.
As with recommendation 3, operational parameters that assist clinicians in identifying ‘time-sensitive health conditions’ will need to be developed. If the processes used for patients with time-sensitive health conditions are changed in accordance with Recommendation 3 and Recommendation 4 it could shorten considerably the time taken to transition the care of these patients to the services they require for definitive treatment.