Lost in Transition Exploring continuity of care through HDC complaints.

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