Improving communication between hospitals and General Practice

In this podcast, Associate Professor Charlotte Hespe talks about improving communication between hospitals and general practice, the current issues, as well as strategies to improve it in the future.

Summary Writer:  Dennis Neuen

Script Writer:  Elizabeth Campbell

Editor:  Charlotte Hespe

Interviewee: Charlotte Hespe

About Charlotte Hespe

Charlotte Hespe is a GP Clinician and Practice Owner of a general practice in Inner City, Sydney, where she has worked for the last 20 years. Charlotte is a GP Supervisor and the practice is a fully accredited practice that functions as a teaching practice for both medical students and GP Registrars.

Charlotte also works as Associate Professor, Head of General Practice and GP Research for The University of Notre Dame, Australia, School of Medicine, Sydney. She is the current Faculty Chair for NSW/ACT and Vice President, RACGP. She is immediate past Chair for Central and Eastern Sydney PHN and is currently a director on the Board (EIS Health). Charlotte holds an FAICD qualification and has extensive experience in corporate Governance with 17 years’ experience as Chair in several Boards with a Primary health care focus.

She is currently completing a PhD looking at the implementation of best practice for CVD prevention in the Primary care setting using a Quality Improvement model for change.

Improving communication between hospitals and General Practice

With Associate Professor Charlotte Hespe, Head of General Practice at the University of Notre Dame Sydney.

Introduction

On the wards, clinical handover occurs regularly with every change in personnel and shift. Within the same system, all health staff including doctors, nursing and allied health staff communicate in handover on a day-to-day basis to ensure safe and efficient transitions in care for their patients.

However, many people forget that when a patient leaves hospital there must be effective clinical handover between systems. This largely comes in the form of discharge summaries, referral letters and phone calls. This communication is not just a summary of a patient’s admission in hospital, but they are a vital form of clinical handover from the hospital to the primary care system.

Since medicine is a field which is often well-delineated into silos and ‘systems’, specialists and their teams tend to operate in a narrow (and oft sub-specialised) spectrum. At times, this can result in poor communication and fragmented care. So how do we improve communication between hospitals, secondary care, community care, and general practice?

  • Multiple goals of discharge summaries
    • Administrative: coding for accurate provision of funding
    • Emergency Department and hospital medical staff: provide information for future doctors regarding previous admissions to hospital
    • General practice and primary care: summary of admission and plan for follow-up and ongoing care
  • Hard to meet these needs in one succinct document that satisfies multiple stakeholders
  • Junior doctors often see discharge summaries as merely ‘paperwork’
  • Few junior doctors call a patient’s GP on admission or discharge from hospital for a clinical handover
  • Discharge summaries: From the junior doctor perspective, think If I was the person who was reading this document, would I understand:
    • What has happened
    • What has changed and what needs to happen
  • Phone calls: an under-utilised method of communication between the general practice and hospitals
    • Pick up the phone and call a patient’s GP
      • Early on in an admission: for more information about the patient
        • GPs have been treating the same patients for 20 years and know them at their best and worse, through all the medical and social complexities
        • An ED JMO might be thinking: why isn’t this person coping? What is the back story? GPs often know these stories. They know information that patients may be reluctant to give up because they are embarrassed
      • On the day or days leading up to discharge
        • Current state: busy teams, quick ward rounds – “follow up with your GP in next day or two”. The problem is that they may not have a regular GP or the practice is booked out for many days or the patient can’t get on to the receptionist
        • Ideally a quick phone call saying: “We’re going to be sending Mr/Mrs. X home in the next 2 days and these are things that we’d like to happen”
        • GPs may be booked out for a number of days for routine appointments, but if a medical officer calls directly and requested an appointment for a specific reason, the GP and practice will fit them in. They can’t do this unless they know they have been in hospital!
  • Sometimes we lose sight of the fact that for many patients, their GP is the person that oversees their overall care
  • In hospital, patients are acutely unwell and vulnerable. When they go home, everything has to be packed up and carried on, for much longer than their stay in hospital
  • The GP is the ongoing link, the person who knows them best and will facilitate their transition and ongoing care
  • Everyone needs to take responsibility – junior doctors, senior doctors working hospital and primary care
  • Warm vs. cold handover
    • “GP to do/chase” or “Dear Doctor/doctornoname” – who are you handing over to?
    • The warm handover involves personal communication,e.g. face-to-face or phone call, where you know what you are specifically responsible for
    • A cold handover involves no personal communication e.g. a faxed discharge summary
  • MyHealthRecord (MHR) will make a big difference
    • Better understanding of what happened in hospital
    • Better understanding of medication changes
  • From a medical perspective, it is a fantastic opportunity for accurate documentation
  • GPs have a responsibility to get things up to date on MHR, patients have a responsibility to encourage GPs to change and update their medical records
  • Not everyone can access your MHR, permission can be limited to certain health professionals
  • Unnecessary doubling up of investigations
  • Lost to follow-up
  • Missed documentation
  • Donot see a discharge summary as ‘paperwork’ or ‘administration’, it is a valuable clinical handover that is vital in transition of a patient from hospital back home
  • Explore the value of personal communication, speak to a patient’s GP on the phone during their admission to find out information, as opposed to ‘chasing’ old notes and health summaries
  • Whether you need to hand something important over, or even if you are simply interested to hear about the outcome of a patient, just pick up the phone and give their GP a call – everyone will benefit and you’ll establish networks on the way!
  • Trace a patient’s journey, including after they leave hospital – you will be much richer for it!

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Tags: #clinical handover,#communication,#community care,#discharge summary,#General Practice,#handover,#junior doctors,#myhealthrecord,#podcast

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