ISQUA16-2683IMPROVING THE QUALITY AND SAFETY OF THE CONSULTATION AND REFERRAL PROCESS: IT'S MORE THAN PROFESSIONALISM AND COLLEGIALITY

Abstract

Objectives: Quality Referral Evolution (QuRE) is a collaborative initiative to make education and support for quality consultation/referral education part of the postgraduate residency training programs in Alberta. QuRE is organized as well for accredited self-study for practicing physicians and surgeons in the province. The QuRE program intends to improve the quality of communications in both the request and response to the consultation/referral process. The provision of better and timelier access to care for Albertans coupled with enhanced and more effective interdisciplinary communication will increase the quality and safety of health services. The QuRE Working Group was established with representatives from Alberta Health Services (AHS), the University of Calgary and the University of Alberta. AHS is the single health authority for the Province of Alberta. AHS delivers medical care on behalf the Government of Alberta's Ministry of Health through 400 facilities (hospitals, clinics, continuing care/mental health facilities and community health sites). Family practice/primary care services are delivered through a network of 43 Primary Care Networks (PCNs) and non-PCN family physicians. Methods: The QuRE Working Group, established in 2015, undertook and completed a comprehensive literature review, identified key components of a quality referral request and that of a quality referral response (or consult note). A two-sided checklist card was developed with suggestions for the requesting physician and the responding physician/surgeon. The QuRE card was trialed and tested by respective practices and modified based on feedback. Based on feedback it has had two (2) revisions. Results: The literature review revealed that most papers focussed on the expectations or quality inclusion criteria in primarily written communication by either requesting physicians' or in consulting physicians' responses, but seldom in both. In addition there were few published studies addressing formal education and training in the consultation and referral process, and none of the approaches described addressed the training and assessment of referral and consultative communication processes together nor in multiple disciplines. To date, the QuRE card has been trialed by family physicians and consultant specialists alike. It has been the focus of workshops and scientific presentation in Alberta and across Canada. The literature review has informed our educational presentations, processes and products and penetrated resident modules and associated enduring educational materials. These include case-based worksheets, video presentations, and a pocket consultation checklist for guidance, assessment or evaluation. Over 1800 QuRE pocket guides have been distributed to postgraduate residents/registrars and practicing physicians/surgeons. Conclusion: Citizens of all countries should expect their health professionals to be highly skilled in essential communication skills needed in health services delivery. Undergraduate and postgraduate health professions schools need to promote formal multi-disciplinary approaches, such as our QuRE program, to provide work-based training and assessment for the important communication skills that are essential for safe, high-quality referral and consultation processes. These approaches should stress the shared principles and processes of communication for both the requesting and responding health professional.