Recall and Reminder Policy and Procedure Manual Best Practice

2010 Recall and Reminder Policy and Procedure Manual Best Practice Contains the practice policy plus all relevant procedures Tracey Roebuck [GP Association of Geelong] 1/9/2010 1

TABLE OF CONTENTS RECALL & REMINDER FOLLOW UP POLICY... 3 PROCEDURE MANUAL... 5 1. Follow-up Procedure:... 5 2. Sample Patient Information Sheet... 7 3. Recall letter for patients unable to be contacted by telephone... 8 4. Reminder Letter... 9 5. Cleaning Up the Reminder System... 10 6. Adding a Reminder... 15 7. Mark as Performed... 17 8. Sending Reminders/Recall Letters... 18 9. Resend Reminders (Previously Sent Reminders)... 20 2

RECALL & REMINDER FOLLOW UP POLICY Policy Purpose: To ensure follow up of significant tests, results and referrals Responsibility: It is the responsibility of GPs ordering tests, investigations or referrals, to set up a reminder prompt to check for expected returning results, reports and correspondence, and to initiate a system of follow up as required (for missing results / reports/ correspondence). It is the responsibility of the GP to check all incoming results, reports and correspondence, and to initiate follow up as required. It is the responsibility of the practice nurse to conduct the monthly follow-up searches and alert the GP where tests, correspondence from specialists have not been received, or where patients have not responded to recalls. It is the responsibility of reception to alert the relevant health practitioner when a patient fails to attend a recall appointment. It is the responsibility of all health practitioners within the practice to alert a patient to an overdue recall/ reminder if detected.eg It appears as though your Pap Smear is overdue. Can you make an appt to see your GP ASAP? This verbal reminder should be documented in the patient file. Policy Statement: It is the policy of...medical Centre that all patients will receive follow-up where it is deemed clinically significant. Follow up can mean: Follow-up information: eg where tests, results, correspondence has not been received back at the practice Follow-up the patient: To discuss reports, tests, results, correspondence and then treat. To follow up the patient where they have not attended a specialist referral or had ordered tests/ investigations To perform preventive health checks or to manage a known condition The level of risk related to failure to follow-up increases with the level of clinical significance of tests, results/ referrals that were ordered. The GP or the nurse will use clinical judgement to decide the level of significance of the referrals and tests ordered in order to determine whether a recall should be set. Clinically significant tests, results, correspondence are followed up according to procedure 1.5 All staff at this medical practice are aware of the need for confidentiality and discretion, with regard to results, reports and correspondence. The practice is proactive about maintaining current contact details for patients of this practice. Information about the reminder recall system is provided via waiting room notices and patient information sheets. Patients may opt out of the system. This decision to opt out is recorded in the patient file. 3

Policy Implementation Strategies: Quality Assurance Mechanisms Relevant Procedure Documents:. Medical Centre ensures that the relevant staff members are trained in the use of the recall and reminder system. Prompt sheets for all aspects of the recall and reminder system are available and filed in the Practice Policy and Procedure Manual (see document list below). Training in recall and reminder software systems for new staff members can be sourced from the GP Association of Geelong. This policy shall be reviewed within months to ensure its continuing efficacy 1. Follow-up Procedure 2. Patient Information Sheet and Opt Out Form 3. Recall letter for patients unable to be contacted by telephone 4. Reminder Letter for a routine check 5. Cleaning Up The Reminder System 6. Setting and Editing Recalls 7. Marking as Performed 8. Resending Recalls 4

PROCEDURE MANUAL 1. Follow up Procedure: The follow-up procedure at..medical Practice is as follows: 1.1 Contact Details: Reception staff routinely verifies patients contact details and Medicare Number when patients arrive at the practice 1.2 Tracking and Following-up Ordered Tests, Investigations, and Referrals: GPs add a reminder prompt for an appropriate time interval when ordering clinically significant tests, investigations or referrals. The practice nurse checks the reminders on a weekly basis to detect any tests, investigations or referrals that have not had results, reports or correspondence returned, and notifies the GP. The GP initiates or delegates follow up in a timely manner of expected results, reports and correspondence that have not been received. The patient is contacted by phone or letter. The outcome of this contact is documented in the patient file and either: More time given to patient to attend for test, investigation or appointment Contact is made with the diagnostic laboratory if the patient indicates the investigations have already been undertaken Contact is made with the specialists rooms if the patient indicates the appointment has been attended If the patients refuses the test, investigation or referral, their refusal of treatment or advice is documented in their medical file 1.3 Reviewing Of Results: Doctors (or a delegated doctor) review the results in the inbox, select the appropriate action and, if needed, create an electronic reminder or action with an appropriate time frame (depending on urgency). If follow-up is required, the GP or a delegated staff member contacts the patient. The necessity for follow-up is documented in the patient file. The decision and extent of responsibility to follow up depends on: The probability the patient will be harmed without follow up The degree of likely harm The burden of taking steps to avoid the risk of harm All correspondence in relating to a referral is checked by the GP and initialed. The GP will add results, or delegate the practice nurse to add results, as appropriate (eg foot and eye checks for diabetic patients in the annual cycle of care). If deemed necessary by the GP, the letter will be scanned by reception and added to patient file. 1.4 Notifying of Results: Patients are advised whether the practice will notify them of the results or required follow up, or whether it is their own responsibility to seek the results of their tests. Patients telephoning or presenting to reception for results should be correctly identified before being given any results or referral letter. 5

1.5 Follow-Up of Clinically Significant Results/ Reports/ Correspondence: GP phones or asks reception to phone the patient. If there is no answer, repeated attempts (at least 3) are made on different days at different times of the day. If still no contact is made, a letter is sent. Letter to be saved in correspondence out. If still no response a letter is sent by registered mail. All attempts to contact patient are made in the patient file. 1.6 Managing Recall Appointments Recall appointments should be booked in clearly as recalls. If a patient fails to attend the GP is notified by the reception staff. The GP initiates follow-up or delegates follow up in a timely manner to rebook an appointment time. Each attempt to contact the patient is noted in the patient file. Recalls are not marked as performed until the consultation has taken place, and remain on the reminder list for ongoing recall, until such a time as the practice deems that all reasonable attempts to contact the patient to come in for the consultation has been made. The level of persistence depends on the clinical significance of the recall and is made at the discretion of the health practitioner. 1.7 Informed Consent Patients are informed through waiting room notices and patient information sheets about the recall and reminder system at the practice. Patients can elect to opt out of the system for preventive health recalls (as opposed to recalls for clinically significant results). Recall letters will contain the reason for the recall, why the recall is important, and the frequency of recalls to expect for this issue. Consent is assumed if the patient has been given the patient information sheet and has not elected to complete the opt out request form. The consent is then documented in the patient file. 1.8 Opt Out Policy Patients can elect to opt out of recall for non urgent preventive health, as long as they have made an informed decision (e.g. as per the patient information sheet). This decision to be excluded from reminder recalls for non urgent or ongoing disease maintenance issues will be recorded in the patient file. 1.9 Registers: Patient Consent will be sort before transferring patient information to national registers for preventive care ( eg ACIR, Pap Screen). Practice based registers will be developed and kept current by an appointed staff member. 2.0 Preventive Care Recalls: Patients with a specified medical condition (e.g. diabetes) or who are in a specific age group (e.g. over 75) or with specific risk factors (e.g. ATSI) are placed on a practice register and, subject to patient consent being granted, be subject to appropriate reminders. 6

2. Sample Patient Information Sheet Name & Address of Practice RECALL & REMINDER SYSTEM This practice uses a Recall and Reminder system to provide preventive care for its patients, to follow up abnormal or significant test results, to manage patients with chronic disease, and to ensure important health checks are not forgotten and are performed. This will assist the practice in ensuring that important health checks are not forgotten and are performed on time, as well as ensuring that significant results are discussed. We will use information from your health record to tell us when appropriate check-ups or tests are due. By allowing us to send you a reminder letter, you will help us to detect serious conditions early and to monitor and manage known conditions. This can significantly improve the long-term outcome for you. In some cases, the reminders can also be sent from other places, e.g. Australian Immunisation Register (ACIR), or from Pap smear Registry. Our doctors follow the guidelines for preventive care as outlined in the Royal Australian College of General Practitioners Guidelines for Preventive Activities in General Practice. The guidelines are in line with the recommendations of organisations such as the National Health and Medical Research Council, the National Heart Foundation and others. If you elect not to be part of our recall and reminder system, please complete the form below, and a note will be made in your file. Even when you agree to be included in the Recall and Reminder system, you should remember when you should be tested for certain conditions and should always contact your doctor to get the results of a test that has been performed. We may not always be able to reach you, especially if you have moved and the contact information on your record has not been updated. Please discuss with your doctor any concerns you have or if you wish your doctor to make clear anything to do with the Recall and Reminder system. Date././. To: Practice A I of..do not wish to be part of your recall system. Please remove my name from your list. Signed.. 7

3. Recall letter for patients unable to be contacted by telephone (Patient Details) (date) Dear. Results of your recent test (insert test name) have been received by your doctor. We have been unable to contact you by phone, despite making several attempts over the last few days. Please contact the Clinic on 52 to make an appointment time with the doctor to discuss your results. Thank you Yours sincerely (Dr Details)

4. Reminder Letter (Patient Details) (date) Dear. A reminder that your repeat/ annual/ monthly/ quarterly/ half yearly check is now due. Please contact the Clinic on 52 to arrange an appointment with our practice nurse,.. If you have had this check, test at another clinic, please let us know so we can update your records. Please contact us with any queries. Yours sincerely (Dr Details) 9

5. Cleaning Up the Reminder System 1. From the main screen click on Set up and them Configurations (you will need to have the appropriate permission level for this) 2. Click on the Reminders box on the left hand menu 10

3. Scroll down the list and find the menu item you wish to edit / delete. Highlight the item and press edit or remove. In this example we are pressing remove (of diabetes review). 4. As you can see diabetes review is no longer on the menu 11

5. To Add a reminder reason: click on add and type in your reason in the reminder box 6. Your new reminder reason is now in the menu 9. Please note, you can edit a reminder reason using the same process 12

Cleaning Up / Linking Old Reminders Once you have set up your reminder menu, you can link current obsolete reminders to the appropriate reminder menu item. Repeating step 1 & 2 of the previous document, now click on the Clean-up Button The left menu is current reminders attached to individual patient files. The right column is your finalized reminder menu. Highlight the current reminder in the left hand column and then highlight the item from the reminder menu that you are linking it to. Then Click on Change. In this case I am linking a current reminder of Fluvax with the reminder menu item of Influenza Immunisation. Next, Click yes. 13

Fluvax has disappeared from the left-hand menu. Those files with that reminder on them will now appear in a recall search for Influenza Immunisation. To prevent new free type and unwanted reminder menu items corrupting your menu choice, remove the tick from the Allow Free Type Reminders below and click Save. 14

6. Adding a Reminder From within a patient file, click on the reminder button Now click on New 15

Select the doctor, the reminder and the interval you require. If this is an ongoing recall click on automatically update this reminder went sent to patient. Click Save Editing A Reminder: Instead of clicking on New, click on edit, and change details as required Please Note: You can also add a reminder from Clinical/Reminders through file/ Add Reminder. You can also go to the reminder screen by clicking on the Mail icon the front screen located on 16

7. Mark as Performed When a patient visits with regard to a reminder, the reminder should be marked as Performed so that it no longer appears when checking for reminders that need to be resent. To do this, open the patient s record and highlight the reminder. Right click and select Mark item as performed. This will save you from the tedious process of manually doing it from the search list as described above. 17

8. Sending Reminders/Recall Letters From the front screen of Best practice, click on Clinical/ reminders. Click on Select Patients Select your reminder criteria and click OK 18

Remove any reminders on the list that have already been performed (but not marked) and click on Send reminders. Please note that Remove reminders just removes them this time around, and they will still be there if you repeat this search, whereas Delete reminders permanently removes the reminder from a patient file. Click on Mail merge and ensure the boxes for Mark as Sent and Add a new reminder for those marked as auto update are ticked. Click on Send. Now select the relevant letter template and open and proceed 19

9. Resend Reminders (Previously Sent Reminders) For some reminder types, it is a requirement that a series of reminder letters be sent to the patient (ie for those patients who have not actioned the reminder). From the front screen, choose clinical / reminders Now select View > Sent Reminders to identify reminders that have previously been sent and have not been actioned. 20

The Previously sent reminders screen will be displayed. By default the screen will display all reminders sent during the past year that are still marked as Unactioned. Various filters can be used to change the sent reminders displayed on the screen 1. Show unactioned only leave this ticked as you are only wanting those patients in the list that have not responded to their first reminder NB: If the GP or nurse has not actioned the file for patients that have already responded to the first reminder, you will have people on the list who have in fact been seen. To deal with this, highlight that reminder and click the Mark button. This will remove this patient from the list by doing the same as the Mark as performed function within the patient record (see section below for details) 21

2. Show all patients leave ticked. (Only untick to bring up an individual patient file to show sent reminders records for) 3. Sent on or after and Sent on or before use these filters to display a list of sent reminders. 4. By doctor use this filter to display reminders related to individual doctors 5. Reason use this filter to display reminders related to individual reminder reasons ( In this instance choose you reminder reason for the 3 rd dose of gardasil) Sending the Reminders: Once you are happy your list is who you want to send a second lot of reminders to, click the Send again this function can be used to send another round of reminder letters, etc. The entire list of patients on the screen will be included. Make sure you have ticked the Mark as Sent box. You may also wish to save a copy in the patient file and auto update this reminder in the patient files to the next reminder period. Obviously if it is a self limited thing like the gardasil vaccine, and they are at the end of their doses, you would remove the tick from Add a new reminder for those marked for auto update..this is more useful for on going things like pap smear reminders Once a reminder has been printed and the mark as sent tick box selected, the reminder will be shown on the patient s record as sent. As they are marked as sent they will no longer appear on the Clinical > Reminders screen when you use the Select patients button. You will however be able to find them again (if they don t respond to their reminder letter) by repeating this process and going from the front screen to clinical/ reminders and then to view/sent reminders. 22