Communication Matters Importance of feedback and Communication

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Communication MattersImportance of feedback and
Communication

• Dr Sharon Monagle, MBBS, FRACGP, MPH

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Communication matters

• 1. Feedback to GPs why does it matter?
• 2. Case examples
• 3. Good feedback
• When, How, What

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Feedback to GPs Why does it matter?

• gt85 of Australians have a nominated GP and,
  will see a GP at least once each year
• gt90 of contacts with the health system occur in
  general practice

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Feedback to GPs Why does it matter?

• In the past 2 weeks, 4 of people have used a
  hospital service
• In the same period 25 of people (and 45 of
  thosegt75yo) have been to a GP
• Source ABS 2002

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Feedback to GPs Why does it matter?

• Relative lack of evidence on the impact of
  transfer of information between primary care
  providers
• Lessons from the Acute-Primary care interface
• -decreased medication misadventure
• -improved self management capacity
• -reduced unplanned health service utilisation
• In the same period 25 of people (and 45 of
  thosegt75yo) have been to a GP
• Source ABS 2002

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• Case Examples

Mrs S 42 yo Alcohol use 4-6 SD per day Referred
by GP to Drug and Alcohol Service at CHS
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• Case Examples

Counselling provided over 4 months Referred on to
Addiction Med Specialist in CHS Commenced
Campral No GP feedback
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• Case Examples

8 months after initial GP referral Mrs S is seen
by GP with persistent hypertension Commenced
Coversyl 4 months later noted to have severe
renal impairment due to drug combination
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• Case Examples

Lesson Lack of correspondence from CHS to GP
resulted in serious drug interaction We cannot
always expect that patients will pass on relevant
information (or appreciate the relevance)
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• Case Examples

Mr J Presented to GP with long list of problems
repeat scripts, BP review, discuss recent blood
tests At end of consultation requests referral to
CHS podiatry Waiting room full
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Case Examples

• GP writes brief referral
• Thanks for seeing Mr J for review of his feet
• Medications listed
• Yours sincerely

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• Case Examples

4 weeks later, GP receives letter from CHS
podiatry re inappropriate referral, -
dreadful - lack of relevant information -
inability to assess and triage the
referral Thereforedelay in service for the client
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• Case Examples

Lesson It takes 2 to tango! Clients are assisted
by good communication from GP ? CHS GP ? CHS
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Case Examples

• In some instances communication from general
  practice can be supported
• by referral guidelines,
• clear eligibility criteria,
• Encouraging (? requiring) use of
• standard referral forms

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Case Examples
Summary Failure to communicate may led to
delayed diagnosis, adverse patient outcomes,
unnecessary service utilisation, client confusion
and disengagement from their care AND
professional dissatisfaction, loss of confidence,
etc
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Good feedback What is it?

• When
• How
• What

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Good feedback What is it?

• When? How? What?
• Not at all

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Good feedback What is it?
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Good feedback What is it?

• When? How? What?
• Acknowledgement of receipt of referral
• Advice that patient placed on WL
• Advice that appointment offered
• Advice that appointment made
• Record of consultation whenever patient seen
• Feedback re ongoing management
• Advice re secondary referrals
• Feedback when patient discharged from service

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Good feedback What is it?

• When? How? What?
• Phone call, Fax, Email, Letter

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Good feedback What is it?

• When? How? What?
• At key points in the patient journey
• Using agreed/preferred means
• To handover important information
• To work together to assist the patient

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• What would I need to know
• if I was providing care to this patient
• tomorrow?

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Working Together!
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Good Communication
..can be exhausting