Improving transfer of care for patients on the NSW north coast

Dr Adrian Gilliland is a key driver of a program to improve the transition of care and transfer of crucial patient information among health providers on the New South Wales North and Mid North Coast. He spoke with the joint Local Health District/Primary Health Network Project Manager, Isabel Butron, about impacts on patients and providers of the Safe Transition of Care program.  Adrian is a general practitioner and is chair of the Mid North Coast (MNC) Clinical Council and board member of the MNC Division of General Practice.

Isabel: Patients outside of urban centres often have to wait longer or travel more to see a GP or to access emergency care. When they do see a GP or attend a hospital, they often assume their care-related information flows seamlessly between GPs and hospital doctors. From your experience, what sorts of challenges surround care transfers and are there any specific issues in regional and rural settings?

Adrian: Emergency Department (ED) doctors and health professionals often need to share electronic summaries that community based GPs and nurses need to pick up and continue. In rural and remote Australia, where there are limited services and greater workforce pressures, it is even more important that GPs get timely messages about what happened to their patient in hospital and vice versa. In our project we’ve seen many examples where transfer or discharge summaries were sent but not received, and where hospitals see the same patients return due to missed opportunities in the community. Time is spent running around to get the information while we should be focusing on our patient’s needs. Some of our patients travel a substantial distance to see us - not knowing that the patient has been in hospital is a very serious concern. Both general practice and the hospital sector often struggle to fix these issues alone.

Isabel: How did the project get input from clinicians about the challenges around shared electronic communications, and what kinds of areas did it focus on?

Adrian: Clinicians raised the issues and concerns in a number of forums. We heard that the timeliness and quality of the discharge summaries were inconsistent. We just didn’t know what the barriers were, nor how to go about trying to rectify the problem. Therefore, in collaboration with the Primary Health Network and our Local Health District, we sought to identify the barriers and develop recommendations for improving the timeliness and quality of discharge summaries.

It seems clear that the timeliness and quality of this kind of information is extremely critical for the safety and high standard of care our rural and regional patients. Supporting health professionals working on rural and remote areas to communicate effectively is vital.
 
Isabel: What do you think has been unique in this project and have you seen benefits from this project in your own practice?

Adrian: This project has had some big impacts to the North/Mid North Coast. We have seen stronger relationships formed between each of the hospitals and between the Primary Health Network and hospitals. Shared planning and shared solutions are contributing to better outcomes.

Within my own practice we have seen an increase in the timeliness of discharge summaries coming in. We now have a concise discharge notification from our hospital Emergency Department. We have seen an increase in the receipt of Mental Health discharge summaries.

Isabel: Finally, what is your message to our regional area?

Adrian:  Safe Transition of Care is a big piece of work and we have only begun. In the future we will need to focus on primary care changes and improvements. We want to improve continuously to ensure our patient’s safety.

Dr Grant Rogers, Rural eMeds Chief Medical Officer/Clinical Lead, NSW Ministry of Health Rural eHealth Program said:

“With the coming implementation of the eMeds electronic medication management system to 112 public hospitals across the rural local health districts in New South Wales, we hope this will contribute to the quality of discharge summaries and enhance the Transition of Care efforts to date. Integrating care between Local Health Districts, Primary Health Networks, GPs and community health services is vital in improving the patient’s journey.”.

The Safe Transition of Care program is continuing to set priorities locally and to look at at further communication improvements between hospitals and GPs.