Background/Problem

Challenges & Next Steps

IMPROVING ACCESS TO SPECIALIST CARE:

The Evolution of a Regional Referral and Acknowledgment Form

Ken Gin, MD, Joy Russell, MD, Moe Baloo, MHA

“I have hundreds of forms in my referral folder, it can get unwieldy. Sometimes I spend a lot of

time looking for the correct form”.

“Time consuming and hard to find the correct form”

“hard to keep track of which forms for which office/doctor”

Proposed Solution

Over a period of 18 months with input from over 20 specialists, 30 family physicians, patients, MOA’s, and administrative leaders, a comprehensive

regional referral form was developed that includes over 30 outpatient cardiology clinics from throughout VCH. In addition, mechanisms to ensure the

appropriate inclusion of relevant information as well as a process to ensure timely acknowledgment of the referral has been embedded in the form.

Evaluation Results and Summary

Phase 1 - Over the trial 3 month pilot period:

• 72 referrals were faxed between January 1 – March 31, 2015

• 75% were acknowledged

• Average time to acknowledgement was 5 days (range 0 to 26 days)

• 42% were within 72 hours

• Average time to appointment was 34 days

• 82% of the referrals went to a specific cardiologist

• 18% went to a VCH cardiology ambulatory clinic

Phase 2 – Based on pre-and post survey questions:

• All family physicians reported an increased knowledge of cardiology services

• 38% of specialists said referrals contained more relevant information compared to

6% prior to using the form

• Overall, 67% of family physicians and 62% of specialists said the referral process

had improved after using the form

We wish to acknowledge and thank the Cardiology-Family Medicine Working Group for their time and contribution to this initiative: Drs. Ken Gin, Andy Ignaszewski, Victor Huckell, Carolyn Taylor, Robert Boone, Graham Wong, Robert Moss, PK Lee, Jonathan Tang, Simone Cowan, Joy Russell, Margo Sweeny, Carol Story, Angela Nguan, Sophia Chong, Margaret Tran,

Annemarie Kaan, Suzanne, Nixon, Jo-Anne Thomas, Kandie Parsons, Candy Chen, Sherry Mark, Sue Macdonald, Sheila Pither, Helen Roberts, and Margot Wilson . We also wish to thank Drs. Joanne Yang, Sean Virani, John Vyselaar, Andrew Jakubowski, Yong Dong You, Kevin McLeod, Andrew Krahn, Shanta Chakrabarti, Krishnan, Ramanathan, Sammy Chan,

John Jue, Nathan Brunner, Marla Keiss, Milan Khara, and Gordon Francis for their contributions. Thanks also to administrative and operational leaders, Bethina Abrahams, Michele Perry-Arnesen, Faisal Aziz, Marla Steinberg, Julie Carleton, Amanda Harvey, Karen Lecomte, Jackie Forman, George Lee, Cindy Lawlor, as well as assistants Danilyn Rarama, Debbie

Howe, and Bonnie Kong. Lastly, a very special thanks to Anne Pearall at PHC Forms Support.

• How do we ensure continued support from five distinct tertiary sites?

• How do we ensure patient care is kept ‘closer to home’?

• How can we improve the process for both the referring physician and receiving specialist? (EMR integration, etc.)

• How do we know if we’ve truly improved timely access to specialist care?

Percentage of Family Physicians Percentage of Specialists

reporting an improvement in the reporting an improvement in

the referral process after using in the referral process after

referral form: using the referral form:

The Vancouver Division of Family Practice recently identified access to cardiologists and cardiology services as a key priority area in the day-to-day practice of

family medicine. In particular, challenges with the referral process was noted as it relates to the wide array of specialists, diagnostic testing, clinic locations,

referral forms, wait times for an appointment, and acknowledgment of referrals.

Survey Results of Family Physicians Reporting Challenges with the Referral Process

CARDIOLOGY REFERRAL

REFERRING PROVIDER:

Name:

Date:

PATIENT INFORMATION

Name:

PHN:

DOB: (dd/mmm/yy)

SPECIALTY CLINICS St. Paul’s VGH Richmond Lion’s Gate

Atrial Fibrillation (AFC)

Heart Failure

Cardiac Rehabilitation

Healthy Heart - Prevention/Lipid

Smoking Cessation

Pulmonary Hypertension

Heart Rhythm Device (HRD)

Heart Rhythm Management (HRMC)

BC Inherited Arrhythmia (BCIAP)

Pacific Adult Congenital Heart (PACH)

Heritable Aortopathies (HAC)

Cardiac Obstetrics (COB)

Cardiac Oncology

Women’s Heart Health

Urgent Care

Pre-Heart Transplant

Sports Cardilogy

Rapid Access Chest Pain Clinic