ALBERTA, CANADA
Board Chair requests Health Quality Council of Alberta review of resources, systems and processes impacting Emergency and Urgent Care Services
The chair of the Calgary Health Region (Region), David Tuer, has requested the Health Quality Council of Alberta work in partnership with the Region to undertake a comprehensive review of the entire spectrum of emergency and urgent care services in the Region.
“The Calgary Health Region is committed to providing safe, quality health care services,” said Tuer. “However, the rapid growth in Calgary in recent years has led to increased pressure on the Region’s ability to provide timely treatment for patients visiting our emergency and urgent care facilities. It’s important to note that health regions across Alberta, indeed across Canada, are facing similar challenges.”
Last year alone, 250,000 patients visited Region emergency departments and another 100,000 sought treatment at urgent care centers.
The Health Quality Council of Alberta (HQCA) review will began in September and will conclude in May 2007; at which time the HQCA will report its findings to the Region. Following presentation to the board, the review’s findings and recommendations will be publicly released. Tuer noted that excessive wait times and other problems related to emergency and urgent care in the Region are complex and have multiple contributing causes, most of which are related to challenges external to the Region’s emergency departments and urgent care facilities.
“This review will identify and address all of the contributing factors impacting our health care system,” Tuer said, who added the Region is continually looking at such ways to improve how health care services are delivered as by making adjustments to patient flow throughout the system and through such recent innovations as the creation of the two urgent care centers in south Calgary and in Okotoks.
“The board of directors wants to assure all residents of the Region that the intention of this review is to determine where potential system changes or improvements could be made to our processes and resources,” said Tuer. “We know that despite high patient volumes, the Region’s front-line staff does an exemplary job delivering care each and every day.”
“We are very pleased that the Calgary Health Region has approached the Health Quality Council of Alberta to conduct this important independent quality review,” says Dr. John Cowell, chief executive officer. “Our legislated mandate charges us with helping to create a higher-quality and safer health care system for all Albertans. As we move forward, our review will be guided by the Alberta Quality Matrix for Health, which provides a common lens for viewing the health care system across the following dimensions of quality: acceptability, accessibility, appropriateness, effectiveness, efficiency and safety.”
The Region will work collaboratively with the HQCA throughout the review process; both through direct representation on the review team and through its existing relationship with the Region’s Quality, Safety & Health Information portfolio. Additionally, the review team will receive input from the Region’s Patient Experience Advisory Council. Representation on the review team will be determined by Dr. Cowell. The Calgary Health Region is committed to providing safe, quality health care to the more than one million people it serves.
Reprinted from the Health Quality Council of Alberta website.
NEW BRUNSWICK, CANADA
Council Update
A patient suffered a rare, but catastrophic, complication to a procedure. There was no allegation or evidence of deficient care regarding the procedure itself. When patient’s care was taken over by another physician, the family complained that the first physician had not been available to the family for further discussion. In response, the physician noted that he had made several attempts to meet with the family. In these circumstances, the Complaints and Registration Committee (Committee) noted that, while the first physician was no longer involved in the care of the patient, there may have still have been some benefit to have remained in contact if the family wished.
A child was seen at an after hours clinic. On initial inquiry, it was suggested the child’s problem had been ongoing for some time. Without offering any treatment, the physician stated the child should have been seen by their own physician. In reviewing the matter, the Committee noted in such circumstances patients are often directed away from such clinics. Nevertheless, in these circumstances, once the physician had attended the patient, there was an obligation to provide care appropriate for the circumstances.
A consultant performed a procedure on a patient. Neither the consultant, nor the family physician, communicated the result to the patient. The patient discovered the result inadvertently while attending a third physician on another matter. The patient alleged that the physician performing the procedure had failed to provide appropriate information. In response, the physician noted that the test result was received and normally would have been communicated directly to the patient. However, there had been a breakdown in office procedures in this regard. The Committee noted that, while the test result was positive, it would not have required further treatment. More than likely, however, the patient would have had some ques-tions. The Committee notes that physicians have previously been reminded of the importance of keeping track of results. In these circumstances, the ultimate responsibility for communicating results rests with the physician who performed or ordered a test. In this case, the physician acknowledged that and asserted that procedures had been modified to avoid a repeat occurrence.
There was an allegation from a family that a patient had inappropriately been prescribed narcotics. It was alleged that the physician continued to prescribe narcotics despite strong evidence that the patient was abusing them. In response, the physician acknowledged that the situation had gotten out of control and admitted that some of the treatment decisions were inappropriate. The Committee felt the physician’s approach in this matter, while well intended, was not in the best interest of the patient or her family. The physician acknowledged the error and agreed on remedial measures, as suggested by the Committee.
A patient was seen by a consultant who, among other things, was asked to provide a comment regarding a patient’s claim of disability. The patient alleged that the physician made a remark that the patient’s problems were relatively insignificant. As a consequence, the patient felt the physician’s conclusions were tainted. In response, the physician denied the remarks in question. In reviewing the matter, the Committee could find no evidence that the physician had assessed the patient inappropriately. The Committee understood that, if certain remarks had been made, this might raise questions regarding the objectivity of the assessment. Whether such remarks were made or not, the Committee could not determine. However, there was no evidence that the assessment was compromised.
A physician alleged that a colleague had declined to provide weekend coverage unless a consultation was requested. The second physician denied this was done for billing purposes, but rather, was an administrative tool which was the prevailing policy in the hospital. On reviewing the matter, the Committee could not be certain of the physician’s motivation. Ongoing coverage of patients should occur without impediment and with a free flow of necessary information. The use of a form for a consultation, when a consultation was not performed, could be misleading. The Committee recommended a larger review of the issue.
A patient was admitted with a significant infection. He complained that the hospital physician failed to provide a surgical consult when he requested it and that it was only when another physician was covering that such was done. In response the physician noted that a surgeon had been consulted early and that the patient’s course significantly deteriorated on a weekend when another physician was covering. The Committee reviewed the hospital records, which consistently backed up the physician’s response. The patient had been doing well until the time in question. At that point, with increasing pain and fever, appropriate surgical intervention was done. The Committee did not feel there was anything more the physician could have done over the course of these events.
A patient was seen by a consultant for a number of problems. The patient complained the physician made comments about her body she found offensive. He also made inquiries about her private life she did not feel were relevant. In response the physician asserted that any comments or inquiries were indicated by the clinical situation. On reviewing the matter, the Committee felt the physician’s remarks could have been well intentioned, but could also have been misinterpreted. Physicians must be as conscious as possible as to how certain things may be interpreted by a patient, especially one they are meeting for the first time.
A patient transferred to another physician who, in contrast to the patient’s opinion, felt she was capable of working. An ongoing dispute resulted and continued to the point where the patient was discharged from the practice. The physician asserted that the patient’s best interests were always met. In reviewing the matter, the Committee could find no fault with the care provided.
A patient alleged that he suffered a significant complication as a result of vitamin injections. The physician asserted that such were provided at the patient’s request and there were a number of other risk factors for the patient’s health problems. The Committee agreed. There was no reason to believe the injections had caused the patient’s problems.
A patient suffered a surgical complication relating to the healing of the wound. He attempted to see the surgeon, but was advised by the staff that, since thirty days had passed, a new referral from the family physician was necessary. The patient’s condition worsened, resulting in a prolonged course. In response, the surgeon stated that this was an error on the part of his staff. Accepting that explanation, the Committee recommended that no further action be taken on the matter. However, the Committee wished to reinforce that surgeons remain responsible for postoperative complications. Patients should be seen for such without impediment.
OTHER BUSINESS
In other business, Council:
Approved the draft budget of Atlantic Provinces Medical Peer Review, which was intended to increase the frequency of assessments and expand the number of specialties which could be assessed.
Reviewed a report from the Department of Health regarding an injured patient who had difficulty accessing the services of consultants. It is noted physicians have been reminded that it is improper to deny access for a patient solely because the patient is from another region.
Noted that there were an increasing number of complaints regarding the process of consultations. There were concerns that there were situations where an unnecessary request for a consultation could impede patient care. Council decided to raise the matter with the Department of Health and the Medical Society to consider where changes may improve the situation.
Reprinted from the College of Physicians and Surgeons of New Brunswick website.
NOVA SCOTIA, CANADA
launch of NSPAR
The NSPAR (Nova Scotia Physician Achievement Review) Program was launched by the College in early February 2005 with eligible family physicians. This has been a successful year, with more than 160 family physicians already initiated into NSPAR and the annual goal of 120 having been exceeded. In keeping with its continuous quality improvement philosophy, NSPAR solicits feedback from participating physicians to make ongoing improvements. NSPAR is working with Doctors Nova Scotia to provide some direct support for CME activity for NSPAR-reviewed physicians. This trial initiative will be managed at arm’s length from the College through the cooperation of Doctors Nova Scotia and several practicing physicians who serve as NSPAR program advisors.
Planning is progressing well for the launch of NSPAR with surgeons and medical specialists in fall 2006. Focus groups have been undertaken to gather feedback on the unique needs and concerns of these physicians in preparation for program introduction. NSPAR and College representatives will be available to answer questions at the May Doctors Nova Scotia AGM at the Oak Island Resort. Further information about NSPAR assessment for surgeons and medical specialists will be distributed to College members in the coming months.
Reprinted from the College of Physicians and Surgeons of Nova Scotia website.
London, England
GMC meets in Wales for first time in its 148-year historY
The General Medical Council (GMC) met in Wales on Sept. 7, 2006, for the first time in its 148-year history. The organization, which regulates doctors and registers them to practice in the United Kingdom, set up its Wales office in June last year in Cardiff Bay. Devolution and the establishment of the National Assembly for Wales have brought changes to the structure of the NHS and the delivery and regulation of health care in Wales. Regulation of the medical profession is implemented on a United Kingdom-wide basis rather than to devolved administrations. However, the GMC recognizes the need for regulation to be appropriate to all countries, which is why offices have been established in Edinburgh, Belfast and Cardiff.
This meeting is part of the GMC’s continuing commitment to working effectively across the devolved countries. It confirms the GMC’s responsibility towards ensuring that regulation remains appropriate throughout the United Kingdom. Following the meeting, GMC members will convene with Welsh health leaders including Dr. Brian Gibbons AM, Minister for Health and Social Services and Dr. Tony Jewell, chief medical officer, to discuss how best organizations can work together to ensure patient safety.
At the meeting, the 35 Council members are expected to formally agree a revised edition of Good Medical Practice (GMP), the core guidance for all doctors working in the United Kingdom. This marks the end of a two-year consultation process to find out what patients and the public want from their doctors and what the profession think the right standards should be. The new GMP, to be launched in October 2006, outlines the standard of professional conduct that the public expects from its doctors and provides principles that underpin the GMC’s fitness to practice decisions. Content of GMP has been changed with a major focus on working in partnership with patients, one of the new duties for doctors outlined in the revised document.
“The Wales office works to strengthen links with the National Assembly and other policy bodies in Wales,” said Natalie Drury, GMC head of Welsh Affairs. “On the 7th of September 7 the GMC became a full signatory of the Wales Concordat designed to ensure reviews and inspections are properly coordinated across the country. The meeting further demonstrated the safety of patients in Wales is a priority.”
Welsh regulators work together to support the improvement of health care services
Welsh patients, service users and their caregivers will gain extra reassurance as the General Medical Council (GMC) joins with other health and social care regulators in Wales in a concordat to deliver more effective collaboration and coordination of regulation and programs of external review.
The Wales Concordat is an agreement that sets out what organizations providing health care in Wales can expect from the bodies that inspect, regulate or audit them.
This agreement is the first to be signed by the GMC that relates wholly to Wales. The aim is to support the improvement of services for the public, ensure reviews are well coordinated and to reduce the pressure on front line staff and increase patient safety.
“The GMC is delighted to be joining the Wales Concordat,” said Finlay Scott, chief executive of the GMC. “This will encourage continuous improvement in the quality of patient care by enhancing our ability to work effectively with our partners in Wales.”
“We warmly welcome the GMC as a main signatory to the Wales Concordat,” said Dr Peter Higson, chief executive at the Healthcare Inspectorate Wales, speaking on behalf of the Concordat Steering Group. “The GMC’s participation will make a significant contribution to providing high quality health care services in Wales and maximizing patient safety. We greatly look forward to working together.”
Reprinted from the General Medical Council website.
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