264_PROV.ppt

264Consult Management

Anthony Zollo MD (Lufkin, Texas)Philip B. Irwin, PA-C (Gainesville, Florida)Ako D. Bradford, M.D. (Amarillo, Texas)

Harold D. Bonds MT (ASCP) SC (Jackson, Mississippi)

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Consult Management: A Tool for Improved Performance

Anthony Zollo, MDChief Medical Officer

Charles Wilson Outpatient ClinicLufkin, Texas

Michael E. DeBakey VAMCHouston, Texas

South Central VA Health Care Network

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“Physicians who meet in consultation must never quarrel or jeer at one

another”

HippocratesPrecepts VIII

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A Primary Care Visit: A to-do list

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Before seeing the patient

• Review vital signs and today’s nursing assessment

• Review recent lab, x-ray, other results

• Review all notes from other clinicians since last visit

• Review any outside records

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During the visit with the patient

• Greet the patient• Take a focused history and review of systems• Perform focused physical exam• Satisfy all due clinical reminders• Review medications and renew, change, add,

delete as needed• Communicate and provide patient education

on diagnoses, prognosis, key issues and changes in therapy, medications or instructions

• Elicit from the patient and address remaining unaddressed questions or issues

• Discuss plans for future visits

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After the patient leaves

• Order future testing and visits• Write as detailed a progress note as

possible • Request needed consultation visits in

CPRS• Return calls, review abnormal labs,

process view alerts, etc, etc, etc…

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And, by the way, do it all in 20 minutes or less!!

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That leaves about 0.75 minutes to enter a consultation request. Anything more and the next patient will not be seen within the 20 minute time of the

performance measure, and patient satisfaction will suffer.

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Factors for a “best practice” consult request

• Provides easy way for communication of main questions/reason for consult

• Utilizes pick lists, templates, etc. to minimize the need for typing on the part of the requestor

• Does not ask the requestor to retype information that is available elsewhere in the CPRS chart

• Clearly communicates the specialty’s preferences for prerequisites (testing, etc.)

• Is flexible with prerequisites and scheduling depending on patient’s unique situation

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Consultant Factors for a “best practice” consult reply

• Do not repeat (especially cut and paste) extensive information that is not critical to answering the reason for the consult

• Provide clear-cut, specific, reasonable recommendations in the assessment and plan

• Explain how to obtain any unusual tests or treatments recommended

• Clearly communicate what the consultant’s role will be in the future (if any)

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Requestor Factors for “best practice” consult requests

• Clearly communicate reason for consult• Clearly communicate urgency of consult• Clearly communicate any unusual

patient factors (i.e., travel restrictions, location, preferences)

• Clearly define whether the requestor would like ongoing follow-up by the consultant (co-managed care) or a one-time visit

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Requestor behaviors to avoid

• Not being explicit and clear with the questions or reason for consult

• Not providing information that is not available to the consultant in the CPRS chart (i.e.; outside records)

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The 10 Commandments of Consultation

1. Determine and communicate the question

2. Establish the urgency of the consultation

3. Personally assess the patient (do not rely on others)

4. Be as brief as appropriate5. Be specific (in questions and

recommendations)

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The 10 Commandments of Consultation

6. Provide contingency plans7. Honor thy turf8. Teach with tact9. Talk is cheap and effective10.Follow-up is essential

(Goldman, L et al, Arch Int Med, 1983)

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1. Determine the Question

• Study showed in 15% of cases the requestor and consultant had totally different impressions of the reason for the consult

• Another study in diabetics reported no specific question was asked in 24% of cases and consultants ignored the question being asked in another 12%

• Requestor should communicate the question clearly• Consultant should communicate back to the requestor if

there are any doubts or confusion• Studies have shown that consult requestors who clearly

communicate the reasons for the consult are more likely to be satisfied with the result

• Requests to “evaluate and treat” are too vague, inappropriate and unlikely to lead to the best outcome for either party

• CPRS consult templates can facilitate or impede this communication depending on design

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2. Establish Urgency

• Facilitated by CPRS• Emergent or truly urgent requests

should be accompanied by direct clinician to clinician communication

• Communication from the consultant should explain any unusual issues or anticipated delays in completing a consult

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3. Personally assess the patient (do not rely on others)

• One study showed that only 9% of consults were requested to obtain assistance in interpreting data already in the chart

• Consultants bring a unique expertise and a different view of a patient’s condition

• Consultants may extract overlooked information by repeating subjective and objective data collection and assessment

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4. Be as brief as appropriate

• Requestors and Consultants should not pull available data from other parts of CPRS into the consult request or response

• Separate the wheat from the chaff

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5. Be specific (in questions and recommendations)

• Except for the purpose of facilitating academic training, consultation reports should be brief and goal oriented

• Otherwise, key points and recommendations can be lost in a sea of less important musings

• Suggestions that follow should be explicit and clearly related to the matter at hand

• Studies have shown that leaving a long list of suggestions decreased the likelihood that any of them would be followed

• Consultants should resist the temptation to suggest tests that are not crucial to the case

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6. Provide contingency plans

• Consultants should remember that patient situations change and initial recommendations might prove irrelevant with time

• Try to anticipate potential problems or changes

• Try to offer diagnostic and therapeutic options for contingencies

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7. Honor thy turf

• Less of a problem in VHA than in private sector• Requestor should communicate any desire or

expectation for ongoing follow-up• Avoid comments (and especially arguments) in

the notes regarding other subjects or areas outside the consultant’s area of expertise

• Often more than one strategy will likely succeed. If a strategy chosen by the requestor is as likely to succeed as one favored by the consultant, agreement is more appropriate than steadfast insistence on an alternate but equivalent strategy

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8. Teach with tact

• Although brevity and clarity is important, sharing expertise without condescension is often appreciated

• References to key articles may be appreciated but should not replace focused discussion of the recommendations in the case

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9. Talk is cheap- and effective

• There is no substitute for direct person-to-person communication

• This is especially the case if there are unusual circumstances before, during or after the consult

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10. Follow-up is essential

• Consultant should recognize the appropriate time to sign off on a case

• Available mechanisms for communication down the road should be explained (telephone extension, email, new consult, etc.)

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8 Strategies to improve the requestor’s compliance with recommendations

• Perform the consult within 24 hours of the request

• Frequent, regular follow-up, with notes in the chart

• Verbal contact and a positive, professional interaction with the referring physician/service

• Limit recommendations to no more than five (if possible)

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8 Strategies to improve the requestor’s compliance with recommendations

• Recommendations should be directly related to the reason for the consultation

• Phrase recommendations as definitive statements

• Assert the importance of the recommendations• Give precise information about how to order

the recommended diagnostic test and how to administer any recommended treatment

Kammerer & Gross: Medical Consultation, 1988

Examples in CPRS

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What doesn’t work

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What doesn’t work

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Getting better

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Getting better

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A Success: Cardiology

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Key information provided on common diagnoses

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Key information provided on common diagnoses

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Less common conditions also covered

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For simpler questions not requiring a patient visit, no more curbside consults, but recommendations will be documented in

the CPRS chart

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Ordering Procedures

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Key data requested when ordering a procedure

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Consultation success!

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SURGICAL SPECIALTY CONSULTS

Philip B. Irwin, PA-CVascular Surgery

North Florida/South Georgia VAMCGainesville, Florida

Consult Management for Success: Part 2

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Process ImprovementIdentification of the problem

• Surgical specialty care has seen a dramatic increase in requests for service as primary care has expanded

• There are limited resources to address the consults (providers, space, OR utilization)

• Feedback loop was lacking

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Reviewing Consults

• With a high initial rejection rate:– Makes the primary care referring

provider look foolish (they were just asking for help!)

– Makes the specialty care service look stingy (we are refusing to help!)

– Confuses the patient (they just want help!)

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Specialty Care Council Charge 2002

• Charged with developing service contracts

• Open door communication between primary care and specialty care

• CBOCs included in process• Broad applications• Limited impact on actual requests

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Methods of contacting a Consultant

• Phone calls (takes a personal touch)• E-mail (takes knowledge)• By electronic Consult (the new e-

mail)

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Consults

• Request exists apart from the clinic referral guidelines

• Generally are “blank” pieces of paper• Current use of the prerequisite field

is too large and gets ignored

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Fundament Change the Process was needed

• Current process – Service Specific• New Process – Problem Specific• Create a dialog between the services

via the Prerequisite Fields of CPRS

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Third Generation

• Use the prerequisite functionality of CPRS to create a DIALOG

• Initiate consults by PROBLEM

Third Generation Problem List

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AAA by ultrasound

Answer a question? (dialog)

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Immediate Feedback!

Larger AAA by U/S

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Pre-clinical testing is included

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Procedure and history

Urgent/routine pathway

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After 3 clicks, here is the consult

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Results for Vascular

• Electronic consult evaluated May 20, 2003

• Turnkey process transparent to requestor

• Now allowed for urgent and routine consults to be handled differently

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Prior to change 4/2003

N=208

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111

36

31

DC

Complete

Scheduled

Denied

DC 14%Comp 53%Sched 17%Denied 15%

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Results June 2003

First Month, N=160

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58

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DC

Complete

Scheduled

DeniedDC 15%Comp 32%Sched 36%Denied 17%

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Improvements

Four Months later, N = 159

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69

53

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DC

Complete

Scheduled

DeniedDC 11%

Complete 43%

Scheduled 33%

Denied 12 %

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Results

• Saw a 20% reduction in total consults requested per month (208 – 160)

• Saw a 10% reduction in the number of consults denied or discontinued (32% to 23%)

• Easy to use, broad application

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Results (part 2)

• Reduction in the need for a “second visit”

• Increase in the number of patients being appropriately followed in primary care

• Reduce the number of inadequate studies (i.e. CT scans in wrong format)

• Ultimately improves access to specialty care

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Ordering a new consult still begins with the Service…

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Audiology Problem List

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Primary care/specialty care contracts enforced by default

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Established patients screened

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Contact information provided

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Pick a problem

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Ear pain gets re-routed….

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… to ENT

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Dental can include…

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…service connection triage…

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…with information

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ENT problem list…

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Eye consult first step-urgency…

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…and routes to Optometry

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GI Medicine Triage

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Start with brief guidelines…

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…initial workup…

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…and then consult

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Home health care…

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…with listed resources

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Nutrition…

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…has multiple entries

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Podiatry Problem List

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Decision Tree

• Nuclear medicine stress testing was being over utilized

• Unable to meet demand• Cardiology presented in-service

training on workup, had limited change in practice pattern

• Used CPRS to help manage stress testing

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Things to Avoid

• The worst thing that can happen is an unnecessary visit– Makes the patient mad– Wastes clinician’s time– Interferes with sicker patients

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In conclusion

• Problem-oriented patient diagnosis best fit into a problem-oriented consultation system

• CPRS with the use of the prerequisite fields is aptly suited to facilitate the process

• Groundwork must be set out by the service handling the consult

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Conclusion continued

• Refining the questioning process is a worthwhile task

• Helps the Sender and the Receiver

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References

• “Reducing Wait Times for Cardiac Consultation” Federal Practitioner Feb 2005 pp 24-28

• “Why we don’t come: patient perceptions on no-shows” Ann Family Medicine 2004;2:541-545

• Advanced Clinic access portal vaww.vccsportal.med.va.gov/aca/

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Consultations and the Inpatient Provider – A Brief Overview of

Placing the Consult AND Being the Consultant

Ako D. Bradford, M.D.Internal Medicine / Hospitalist

Thomas E. Creek VAMCAmarillo, TX

Southwest VA Health Care Network (VISN 18)


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Inpatient Consults – cont.

• PLACING THE CONSULT

• BEING THE CONSULTANT

•WOMEN’S HEALTH CONSULTS

• An excellent reference text: Kammerer and Gross’ Medical Consultation: The Internist on Surgical, Obstetric, and Psychiatric Services, 3rd ed. (1998). Gross and Caputo, Ed.

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• PLACING THE CONSULT – Daily vs. periodic involvement– Expectations of the Consultant: what do

you want them to do?– Establishing follow-up after discharge– Consult vs. Referral

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• PLACING THE CONSULT: Daily vs. periodic involvement

– May be affected by how the problem is stated

– May be affected by how your hospital provides more specialized / invasive services

– Is this addressed in the service agreement?

– Remember the 9th Consult Commandment?• Talk is cheap – and effective!

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• PLACING THE CONSULT: “Whaddaya want?!?”

– Do you want them to do something... to make the diagnosis... or, to support / refute the diagnosis that YOU have already made?

– How aggressive / proactive is your consultant?

– Is this addressed in the service agreement?

– But, remember the 7th Commandment?• Honor thy turf

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•PLACING THE CONSULT: Establishing hospital follow-up

– May depend upon extent of consultant involvement

– 10th Commandment?• Follow-up is essential

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•PLACING THE CONSULT: Consult vs. Referral

• “A consultation is strictly defined as requesting another physician to give his or her opinion on diagnosis or management. A referral means to request another physician to assume direct responsibility for a portion or for all of the patient’s care.”

– Kammerer and Gross’ Medical Consultation: The Internist on Surgical, Obstetric, and Psychiatric Services, 3rd ed. (1998).

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• BEING THE CONSULTANT– To admit or to consult?– What do they want you to do? – Pre-op evaluation– Resident-managed Consultation Service– Signing Off

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• BEING THE CONSULTANT: To admit or to consult? (A.K.A. “To be, or not to

be…”)

– What is the patient’s primary issue? How is this issue best addressed for their safety?

– Communication and collegiality are essential!

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• BEING THE CONSULTANT: “Whaddaya want?!?”

•The 1st Commandment?– “Determine and communicate the

question”

– “Medical issues” or “follow along” are inappropriate

– How aggressive / proactive do they want you to be?

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• BEING THE CONSULTANT: Pre-op Evaluation

• You do not “clear” a patient; you assess their peri- / intra- / post-operative risks.– Goldman Criteria

• L Goldman et. al. “Multifactorial index of cardiac risk in noncardiac surgical procedures” NEJM 297 (16):845-850. October 20, 1977.

– Qaseem A et. al. “Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: A guideline from the American College of Physicians”. Ann Intern Med. 2006 Apr 18;144(8):575-80.

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• BEING THE CONSULTANT: Resident-managed Consult Service

• One of the greatest benefits: availability– 3rd Commandment?

• Personally assess the patient (do not rely on others)

• Less likely to request a “curbside consult”

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• BEING THE CONSULTANT: Signing off (or, “Like Nike – Just do it!”)

• Professionally courteous.

• Consults can always be re-requested; but, what if it’s for the same thing as before?

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WOMEN’S HEALTH CONSULTS**In the Military . .

• 212,000: Total number of active duty women in the military, as of Sept. 30, 2004. Of that total, 35,100 women were officers and 177,000 were enlisted.(Source: Statistical Abstract of the United States: 2006, Table 501.)

• 15%: Proportion of members of the armed forces who were women, as of Sept. 30, 2004. In 1950, women comprised fewer than 2 percent.(Source: Statistical Abstract of the United States: 2006, Table 501.)

• 1.7 million: The number of military veterans who are women. (Source: Statistical Abstract of the United States: 2006, Table 510.)

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So, what’s the bottom line?• The success of many inpatient

consultations depends upon your relationship with your consultants.

• Don’t be afraid to pick up the phone

• Remember the 10 Consult Commandments

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264 Consult Management: Monitoring for

Performance improvement

Harold D. Bonds MT (ASCP) SCHealth Systems SpecialistG. V. Montgomery VAMC

Jackson, Mississippi


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#264 – Consult Management Monitoring for Performance improvement

• Reasons for monitoring consult from a referring service perspective:

– Provider Utilization• Appropriateness of request (consult reason for

request)• Provider training needs (over utilization vs.

underutilization)

– Timeliness of Response by Consultant for quality patient care

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• Reasons for monitoring consult requests from a consultant perspective

– Provider Utilization• Appropriateness of request (consult reason for

request)• Provider utilization (over utilization vs. under

utilization)

– Monitor Supply and Demand• Demand for services • Timeliness of Care • Clinic Capacity and Utilization • Staffing effectiveness and utilization

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• Data for Monitoring may be collected from several sources:

– VistA Consult Package Reporting Options– Care Management Query Tool– VistA Fileman templates (requires some

programming knowledge for obtaining information from the files)

– VistA Ambulatory Care Reporting Package Options

– National Reports called KLF reports from the Austin Automation Center generated with software created by Kathie Lee Frisbee.

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VistA System Consult Tracking Reports option:

– ST Completion Time Statistics– PC Service Consults Pending Resolution– SH Service Consults Schedule-Management

Report– CC Service Consults Completed– CP Service Consults Completed or Pending Resolution– IFC Interfacility (IFC) Requests– IP Interfacility (IFC) Requests By Patient– IR Interfacility (IFC) Requests by Remote Ordering

Provider– NU Service Consults with Consults Numbers– PI Print Interfacility (IFC) Requests– PL Print Consults by Provider, Location, or

Procedure– PM Consult Performance Monitor Report– PR Print Service Consults by Status– SC Service Consults By Status– TS Print Completion Time Statistics Report

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VistA System Consult Tracking Reports option:– SH Service Consults Schedule-Management

Report• Benefits of this option are:

– Status of the consults:– Service Connection Percentage (Priority

Scheduling)– Total consult numbers at a single glance– Patient appointment linked with consult

• Pitfalls of this option:– Ordering Provider not listed– Reason for Request not indicated– Completion, Cancellation, and Discontinued data

not available




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VistA System Consult Tracking Reports option:– IFC Interfacility (IFC) Requests

• Benefits of this option:– List consults by Requesting or Consulting facility– List status of consults by Requesting or Consulting

facility– Provides totals for each consult service by facility and

overall totals by facility– Provides basic status of consults

• Pitfalls of this option:– Does not indicate Ordering Provider– Does not indicate Reason for Request– Does not indicate Completion, Cancellation, or

Discontinue data– No appointment data not available


IF Consult/Request By Status - Consulting Site FROM: ALL TO: JUN 20,2007

SERVICE: Brachytherapy Discont. PRINTED TO 6/5/2007 CPRS,PATIENTONE 1 VAMCONE

Discont. PRINTED TO 1/11/2007 CPRS,PATIENTTWO 2 VAMCTWO

Discont. PRINTED TO 11/29/2006 CPRS,PATIENTFOUR 4 VAMCTHREE

Discont. PRINTED TO 9/18/2006 CPRS,PATIENTFIVE 5 VAMCFOUR

Discont. DISCONTINUED 2/21/2006 CPRS,PATIENTEIGHT 8 VAMCFIVE

Completed COMPLETE/UPDATE 6/8/2007 CPRS,PATIENTFOURTEEN 14 VAMCTWO

Completed COMPLETE/UPDATE 6/5/2007 CPRS,PATIENTFIFTEEN 15 VAMCTHREE

Completed COMPLETE/UPDATE 5/29/2007 CPRS,PATIENTSIXTEEN 16 VAMCSIX

Completed ADDED COMMENT 5/22/2007 CPRS,PATIENTSEVENTEEN 17 VAMCONE

Completed COMPLETE/UPDATE 5/8/2007 CPRS,PATIENTTWENTYONE 21 VAMCFOUR

Completed COMPLETE/UPDATE 11/29/2006 CPRS,PATIENTFORTY 40 VAMCSEVEN

Completed COMPLETE/UPDATE 9/27/2006 CPRS,PATIENTFORTYEIGHT 48 VAMCEIGHT

Pending PRINTED TO 6/15/2007 CPRS,PATIENTONEHUNDREDSEVEN 107 VAMCONE

Scheduled ADDED COMMENT 6/5/2007 CPRS,PATIENTONEHUNDREDEIGHT 108 VAMCTHREE

Scheduled SCHEDULED 6/1/2007 CPRS,PATIENTONEHUNDREDNINE 109 VAMCTWO

Scheduled ADDED COMMENT 5/30/2007 CPRS,PATIENTONEHUNDREDTEN 110 VAMCEIGHT

Scheduled ADDED COMMENT 1/19/2007 CPRS,PATIENTONEHUNDREDELEVEN 111 VAMCONE

Incomplete INCOMPLETE RPT 12/19/2006 CPRS,PATIENTONEHUNDREDTWELVE 112 VAMCTWO

Cancelled CANCELLED 12/4/2006 CPRS,PATIENTONEHUNDREDTHIRTEEN 113 VAMCFOUR

Cancelled CANCELLED 11/22/2006 CPRS,PATIENTONEHUNDREDFOURTEEN 114 VAMCTWO

Cancelled CANCELLED 2/9/2006 CPRS,PATIENTONEHUNDREDSEVENTEEN 117 VAMCONE

Cancelled ADDED COMMENT 1/17/2006 CPRS,PATIENTONEHUNDREDNINETEEN 118 VAMCFIVE


To Service Brachytherapy Total Requests Discont. 13

To Service Brachytherapy Total Requests Completed 93

To Service Brachytherapy Total Requests Pending 1

To Service Brachytherapy Total Requests Scheduled 4

To Service Brachytherapy Total Requests Incomplete 1

To Service Brachytherapy Total Requests Cancelled 6

Total Requests Pending Resolution To Service Brachytherapy 6

Total Requests To Service Brachytherapy @ VAMCFIVE 2

Total Requests To Service Brachytherapy @ VAMCTHREE 34

Mean Days Completed To Service Brachytherapy @ VAMCTHREE 40

Total Requests To Service Brachytherapy @ VAMCSEVEN 3

Mean Days Completed To Service Brachytherapy @ VAMCSEVEN 26

Total Requests To Service Brachytherapy @ VAMCFOUR 31

Mean Days Completed To Service Brachytherapy @ VAMCFOUR 22

Total Requests To Service Brachytherapy @ VAMCTWO 13

Mean Days Completed To Service Brachytherapy @ VAMCTWO 33

Total Requests To Service Brachytherapy @ VAMCONE 22

Mean Days Completed To Service Brachytherapy @ VAMCONE 16

Total Requests To Service Brachytherapy @ VAMCSIX 5

Mean Days Completed To Service Brachytherapy @ VAMCSIX 10

Total Requests To Service Brachytherapy @ VAMCEIGHT 8

Mean Days Completed To Service Brachytherapy @ VAMCEIGHT 28

Mean Days Completed To Service Brachytherapy 27

Total Requests To Service Brachytherapy 118

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– PL Print Consults by Provider, Location, or Procedure• Benefits of this option:

– Consult Statistics by Ordering Provider, Location or Procedure

» Individually» System wide

• Pitfalls of this option:– Reason for Request not indicated– Completion, Cancellation, or Discontinue data not available– No appointment data not available


Consult# Req Date Ordering Provider Location To Service Patient SSN Status Procedure870286 1-Mar-07 CPRS,PROVIDERONE TELEPHONE-MEDICINE 1st Floor EKG Section p Outpatient EKG - 891272 18-Apr-07 CPRS,PROVIDERONE PC BLUE II-CPRSPROVIDERONE Bariatric Surgery dc852729 19-Jan-07 CPRS,PROVIDERONE PC BLUE II-CPRSPROVIDERONE Blue II PharmD Coag c846273 4-Jan-07 CPRS,PROVIDERONE TELEPHONE-MEDICINE Cardiology c846872 5-Jan-07 CPRS,PROVIDERONE PC BLUE II-CPRSPROVIDERONE Cardiology Procedure Section c Holter - 864685 15-Feb-07 CPRS,PROVIDERONE PC BLUE II-CPRSPROVIDERONE CARVEDILOL c853849 23-Jan-07 CPRS,PROVIDERONE PC BLUE II-CPRSPROVIDERONE CDTP x917365 12-Jun-07 CPRS,PROVIDERONE WALK-IN PRIMARY CARE BLUE II Chiropractic s846163 4-Jan-07 CPRS,PROVIDERONE TELEPHONE-MEDICINE CLOPIDOGREL c845001 2-Jan-07 CPRS,PROVIDERONE PC BLUE II-FLU SHOT Dental (Routine) c862449 12-Feb-07 CPRS,PROVIDERONE PC BLUE II-CPRSPROVIDERONE Dermatology c898586 3-May-07 CPRS,PROVIDERONE PC BLUE II-CPRSPROVIDERONE Diabetic Education (Outpatient) s905014 16-May-07 CPRS,PROVIDERONE PC BLUE II-CPRSPROVIDERONE Diabetic Eye Screening x870947 2-Mar-07 CPRS,PROVIDERONE WALK-IN PRIMARY CARE BLUE II EEG (Neurodiagnostics) c EEG856611 29-Jan-07 CPRS,PROVIDERONE PC BLUE II-CPRSPROVIDERONE Endocrinology (Diabetic) c916724 11-Jun-07 CPRS,PROVIDERONE TELEPHONE-MEDICINE Endocrinology (Non Diabetic) c875238 13-Mar-07 CPRS,PROVIDERONE WALK-IN PRIMARY CARE BLUE II ENT Cerumen Removal c856878 29-Jan-07 CPRS,PROVIDERONE WALK-IN PRIMARY CARE BLUE II Enterostomal Therapy (ET) c902415 10-May-07 CPRS,PROVIDERONE PC BLUE II-CPRSPROVIDERONE EYEGLASS REQUEST INITIAL ORDER c861490 8-Feb-07 CPRS,PROVIDERONE TELEPHONE TRIAGE FLOMAX c898506 3-May-07 CPRS,PROVIDERONE PC BLUE II-CPRSPROVIDERONE Fund Approval (Outpatient) - Medical Service c845166 2-Jan-07 CPRS,PROVIDERONE PC BLUE II-CPRSPROVIDERONE Gastroenterology c897524 1-May-07 CPRS,PROVIDERONE PC BLUE II-CPRSPROVIDERONE General Surgery c


Consult# Req Date Ordering Provider Location To Service Patient SSN Status Procedure854454 23-Jan-07 CPRSREMOTE,PROVIDERFIVE BILOXI VAMC Urology c858708 29-Jan-07 CPRSREMOTE,PROVIDERFIVE BILOXI VAMC Urology s892416 11-Apr-07 CPRSREMOTE,PROVIDERFIVE BILOXI VAMC Urology s891268 12-Apr-07 CPRSREMOTE,PROVIDERFIVE BILOXI VAMC Urology c854207 22-Jan-07 CPRSREMOTE,PROVIDERTHREE BILOXI VAMC Oncology c886279 29-Mar-07 CPRSREMOTE,PROVIDERTHREE BILOXI VAMC Oncology c853309 22-Jan-07 CPRSREMOTE,PROVIDERTHREE BILOXI VAMC Radiation Therapy c878268 17-Mar-07 CPRSREMOTE,PROVIDERTHREE BILOXI VAMC Radiation Therapy dc882240 29-Mar-07 CPRSREMOTE,PROVIDERTHREE BILOXI VAMC Radiation Therapy s

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– PM Consult Performance Monitor Report• Benefit of this option:

– Gives Consult Completion Statistics with Percentages

• Pitfalls of this option:– No Individual consult information available– No appointment data available

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– PR Print Service Consults by Status• Benefits of this option:

– Allows each status to be reviewed/printed separately or together

– Provides numbers of consults in each status– Provides patient information with ordering location

• Pitfalls of this option:– No Ordering provider information– No Reason for Request available– No Completion, Cancellation, or Discontinue data

available– No Appointment data available


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• VistA System Consult Tracking Options:

– There is no one option in the VistA Consult Package that will provide all the information that may be obtained from all five of the reporting options described.

– There is not an option in the VistA Consult Package that will provide the Reason for Request

– There is not an option in the VistA Consult Package that will provide the Completion, Cancellation or Discontinued consult information.

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• Consult cancellation reasons can be retrieved by two methods:– Manually looking at each patient’s Electronic

Medical Record from a list generated with one of the VistA Consult Tracking Options.

– Searching and printing the cancelled consults with the reason for cancellation from the consult files.

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• Consult completion information can be retrieved by two methods:– Manually looking at each patient’s Electronic

Medical Record from a list generated with one of the VistA Consult Tracking Options.

– Searching and printing a list of the completed consults from the consult files with the associated results field populated.

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• Care Management Query Tool:– Benefits:

• Provides report with differing criteria defined by user:– Consult Service– Ordering Provider– Ordering Location– Date Range– Directly exportable report to Microsoft Excel Spreadsheet

– Pitfalls:• Requires specific patient list for search• No Appointment data available• No Reason for Request• No Completion, Cancellation, or Discontinue data

available


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• Ambulatory Care Reporting Package Options:– Benefits:

• Provides statistical data on patient appointments that may be compared to Consult data obtained from the VistA Consult Package

– Pitfalls:• Provides no direct consult data

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• VHA Service Support Center Reports:– Benefits:

• Provides statistical data on patient appointments, wait times, delays, and missed opportunities that may be compared to Consult data obtained from the VistA Consult Package and utilized for performance improvement.

– Pitfalls:• Provides no direct consult data at this time• 5 week lag time before monthly data is

available


VSSC KLF Data Ambulatory Care Option Reports Consult Data

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3 x 5 cards please

264_PROV.ppt

Health & Medicine

urgency of consult

unusual patient factors

patient education

patient satisfaction

patient review vital

requestor factors

review of systems

consultant factors