lost in transition exploring continuity of care through hdc complaints
TRANSCRIPT
Lost in TransitionExploring continuity of care
through HDC complaints
HDC vision: a consumer-centred
system
Consumer Centred System
Engagement
Seamless ServiceCulture
Transparency
What do we mean by continuity of care?
“…extent to which a series of healthcare services is perceived or experienced as connected and coherent and consistent with the health needs and personal circumstances of a patient”
Haggarty et al. BMJ 2003; 327:1219-21
Continuity of Care
• Relational continuity
• Information continuity
• Management continuityHaggarty et al. BMJ 2003; 327:1219-
21
Continuity of Care
Relational continuitypersonal relationships between individual patients and professionals, built on shared experience and interpersonal trust.
Continuity of Care
Management continuity services are delivered in a complementary and timely manner; plans protocols facilitate management continuity, providing a sense of predictability and security in future care for both patients and providers.
Continuity of Care
Informational continuity
how information is transmitted across time, across place of care, and across professional boundaries
Right 4(5)Right to Services of an Appropriate
Standard
Every consumer has the right to
co-operation among providers
to ensure quality and continuity of services.
4. Right to have services provided
1) … with reasonable care and skill.
2) …that comply with legal, professional, ethical, and other relevant standards.
3) …in a manner consistent with his or her needs.
4) …in a manner that minimises the potential harm to, and optimises the quality of life of, that consumer.
Care, co-operation and communciation
• 93 year-old long-term resident• Deterioration• Lack of care• Lack of informational continuity of
care
09HDC01641
09HDC1641
• Right 4 (1) for care• Right 4 (5) – communication between staff• Lack of clarity of roles
– not reading notes– communication with medical staff • Lack of clarity about the system
– documentation
Single provider (GP)
• Two consultations re bleeding, April and July
• November locum sends stool sample, no abnormalities
• December consultation agreement to refer for colonoscopy
• February goes to hospital in pain• stage II cancerous tumour
10HDC00974
10HDC00974
•Forgets to send referral letter
•Did not use a computer reminder system
•Did not tell patient to let him know if no appt
10HDC00974
• Inadequate examinations at earlier appointments
• Inadequate systems for following up/alert on referral
Management of cardiology referral between DHB’s
09HDC01883
DHB 1 (respiratory)
• did not communicate effectively with DHB 2 − Right 4(5)
DHB 2 – (cardiology staff)
• did not obtain sufficient information in phone call
• did not seek a legible copy of the ETT results
• did not appropriately acknowledge the referral
Cauda equina - 10HDC00454
• 29 year-old woman R) sciatic pain• ?disc prolapse• GP consulted orthopaedic surgeon
authorised CT scan• GP – ordered CT– prescribed pain relief, anti-
inflammatory– referred to CT scan
10HDC00454 - GP
should have ensured woman had timely specialist review, by:– Following up on fax and phone message
to specialist– Impressing upon woman need for
urgent review
10HDC00454 - specialist
• Orthopaedic specialist should have tried to track the patient down
HDC vision: a consumer-centred
system
Consumer Centred System
Engagement
Seamless ServiceCulture
Transparency
