Sometimes small initiatives can make a big difference to patient care, and yet as a topic they may seem too ‘simple’ for presentations at a nursing conference. When the complaint was received the urology nurses acknowledged the anxiety caused by the delayed correspondence and the need to improve the timeliness of the communication of a cancer diagnosis to patients GP. The nurses discussed options to address the issues with members of the urology team and a decision was made to develop a single sheet patient record which could be easily completed and forwarded to the GP on the same day as the patient’s clinic appointment.
The following poster titled “New prostate cancer diagnosis: Improving timelines of communication with patient’s General Practitioner,” was not only presented but also won first prize in the Nursing and Allied Health Poster Category at the 2013 Prostate Cancer World Congress. I believe this award recognised both the ability of this small, quality initiative to positively impact on patient care, as well as the ease with which it could be implemented at other urology centres.
As you read this column, you may recall small projects you have undertaken to improve the quality of care in your workplace. Did you consider sharing them with your colleagues either through columns like this one, presentation at conferences or publication in a nursing journal?
The more we share our initiatives with one another, the greater the opportunity we each have to contribute to the overall quality of care for urology patients. This is particularly true if you have taken the time to evaluate their impact on outcomes.
Receiving a diagnosis of prostate cancer can have a detrimental effect on a patient’s psychological, physical and spiritual well-being. Patients who undergo a prostate biopsy to investigate an elevated prostate specific antigen (PSA) or abnormal digital rectal examination (DRE) within our District Health Board (DHB) return to the outpatient clinic approximately two weeks after their biopsy for their histology report.
Although support and information is given by the urologist and /or senior nursing staff during this appointment, a patient’s understanding and uptake of information may be limited due to the stress of a confirmed cancer diagnosis. Patients may seek further assurance and clarification after the clinic appointment from their General Practitioner (GP), with whom they may already have an established therapeutic relationship. It makes sense therefore, to inform the GP of their patient’s diagnosis and any discussed treatment plans in a timely manner, so they can provide appropriate support and information as part of a multidisciplinary model of care.
The motivation for an initiative to improve timelines of communication between our DHB and a patient’s primary health care provider came from a complaint from a GP. The GP was unaware of his patient’s positive prostate cancer diagnosis until contacted by his patient. He felt he was disadvantaged in his ability to provide appropriate support to his patient as he was unaware of the prostate cancer grading and staging. He was also not aware of the treatment options discussed or recommended to his patient.
The barrier to achieving timely notification was the heavy workload of the medical transcriptionists, preventing them from typing correspondence in a prompt manner. At the time of the complaint, letters were taking up to two weeks to be signed off and emailed to the patient’s GP. This has subsequently improved with increased transcription staffing levels and improved processes but the average turnaround time is still around seven days.
The record would give the GP focussed information regarding their patient’s diagnosis, formatted into labelled boxes to reduce the need for hand-written comments. The information would include the date of diagnosis, method of diagnosis, PSA, tumour stage, Gleason score, planned radiological investigations (if any) and treatment options. The treatment options would be rated by the urology health professional as either ‘preferred,’ ‘potential’ or ‘unsuitable.’ The new process was implemented early in 2013 with clinic nurses ensuring the completed patient records were faxed through within hours of the patient consultation. It had been decided that the personalised patient record would be faxed to the GP as this mode of delivery was both prompt and practical. It was also anticipated that the fax mode of delivery would ensure the notification was not delayed in a queue of unread emails in the GPs ‘inbox.’
A GP feedback questionnaire was then designed and used to audit the perceptions of GPs who received the faxed patient records. Over a period of five months questionnaires were faxed to all of the GPs who had previously received a faxed patient record.
A total of 44 questionnaires were sent with 20 returned. This was just under a 50% response rate. Two main questions were asked: Was receiving the information by fax satisfactory? Was the format of ‘Patient Record’ satisfactory? GPs were also asked to comment on whether the receipt of the record resulted in any action on their part and if there was any further information they would have like included.
Results revealed that 93% of GP’s were satisfied with a faxed mode of delivery, while 7% would have preferred electronic format. 86% were satisfied with the format of the record, while those that commented on improving the format requested an electronic version. 79% of GPs found the information provided was adequate.
Comments from GPs to improve information included providing a full histology report, more advice for the GP and legible handwriting! Fifty percent of the GP’s indicated that receipt of the patient record prompted action on their part, including contacting their patients and updating the patient’s charts. After reviewing the audit findings no modifications were made to the original patient record.
The patient record is viewed as a simple tool that efficiently provides essential information to the GP prior to the more detailed clinic letter arriving. The tick box format limits the need for handwriting although the health care professional completing the record is required to write their name and title on the record for reference.
This change to improve inter-professional communication regarding a patient with newly diagnosed cancer recognises the GP’s role in managing their patient’s health. The GP’s positive response in receiving this information and the success of this patient record has led to an extension of its use to ‘potential’ bladder and renal cancer patients, and where patients have been informed of the likely diagnosis either at the time of cystoscopy or following radiological imaging.
North Shore Hospital