Friday, November 16, 2007

Uphill Both Ways

Wow! A month away from this blog. It's hard to get back to putting pixels on paper. We're making slow progress with the project, but have had some challenges over the last month. Here's an overview:

Working down the backlog is still our main goal. We've realized that we won't see the end of the backlog by November 30. This month, four out of nine urologists are on holidays. The rest of us are doing our regular work as well as looking after lab results and returning patient phone calls for our vacationing partners. There's not a lot of free time (or much appetite) for adding extra office visits. Even so, Amanda continues to recruit (successfully!) for working evening office hours (5-6 pm, once a week for each doctor). Also, our part-time partners continue to come back to work on their "month off" to work extra days.

December is also going to be a difficult month in which to mobilize extra effort toward the backlog. Hospital holiday slowdown at the end of the month should free up some of us to do extra work at the office. On the other hand, when the hospitals slowdown, we plan for half of us to take holidays over Christmas week and the other half are off New Years week. We'll try to work through as much backlog as possible over the holidays. I'm hopeful that our efforts in January and February will set us up to wipe out the backlog by the end of February.

The other project we're working on is partnering with referring physicians to become more efficient in assessing common urologic conditions. I used hematuria (blood in the urine) as an example in "Accounting for Demand". We've developed a checklist of information we need when seeing patient with hematuria. Amanda has faxed it out to several of the large family medicine clinics in Saskatoon. We've also posted the cover letter and checklist on our practice website. Referring physicians can access it there, but we're also planning to do a fax campaign. We'll fax the cover letter and checklist to referring physicians whenever we fax them any of our consultation letters. This way, we should get a wide distribution of the checklist without needing to do a formal mail-out.

By communicating the information we need, we hope to streamline our workup of patients with hematuria. If all the information arrives at my office before the patient's visit, I should be able to give a final answer at that visit, rather than needing to collect results afterward and then contact the patient later. That translates to better patient care and satisfaction, and less work for my and the referring doctor's staff.

The referring physician information on our practice website is not password protected or access restricted in any way. My hope is that patients will look at these guidelines and partner with their physicians to ensure the necessary investigations are completed before they see the urologist.

I'm doing a quick and dirty survey of current hematuria referral practices. I'm looking at referrals we received before this initiative, and recording which pieces of information were provided at the time of the referral. Then I'll record the same data for referrals received after our fax campaign started.

The idea of guidelines for referring physicians was received very well at our last practice meeting. The urologists would like to try a similar process for other conditions such as enlarged prostate and erectile dysfunction. We'll see how the hematuria guidelines work first.

P.S. - Advanced Access in Saskatoon made the front page of the National Post last week. (Sorry if this link dies in the future.)


  1. Originally posted by Maureen Klenk (Chairperson, Nurse Practitioners of Saskatchewan) 11/16/2007 1:20 PM

    I really like your latest posting in which you are attempting decrease wait times by increasing efficiency in the system. Posting 'work- up' information for 'common urological conditions' that are referred to a urologist is an attempt to ensure that the patients that need to see you are coming to you ready to be seen.

    But another way to reduce wait times could be....

    I would like to invite you to visualize a province where every provider is working toward decreasing waitlists, by having the right provider, provide the right care to the right patient at the right time. As Chairperson of the Nurse Practitioners of Saskatchewan I am advocating for a team approach to health care where, as research as shown, 80% of family physician visits can be managed by a Nurse Practitioner. This would then free up more time for the family physician to more effectively manage the care of the 'common medical conditions' referred to specialists such as yourself. And as was mentioned in a previous blog posting by yourself - family physicians could also manage the routine post - operative care of such patients as well. Do you think a system such as I have described could provide the people of Saskatchewan with collaborative health care that is patient-centred? Do you think a system such as this could also eliminate waitlists - with out the heavy burden that your office staff and physicians are currently putting themselves through to eliminate the backlog?

    Again, I commend your efforts and wish you every luck. I am all for efficiency in the system. Please consider lending your voice to health care professional groups such as mine to advocate for a provincial wide system where waitlists are non-existent. NPOS believes in having the appropriate providers providing primary care is another way to accomplish this same result.

  2. Originally posted by Jefferson Ripley 12/10/2007 9:15 AM

    I am currently on the wait list for a vasectomy. I'm scheduled with Dr. Jana. My G.P. referred my case to Urology September 13, 2007. I didn't receive a letter from Urology after a few weeks so I followed up with the Kenderdine Clinic to see if the referral had been sent to Urology. The Kenderdine clinic said it had been faxed over. I phoned Urology but my name was not on the wait list. The reception at Urology told me that as soon as faxes come in that the name was added to the list, so they probably hadn't faxed the referral yet. I then phoned back to Kenderdine Clinic and they refaxed the referral. I did receive a letter from Urology after those conversations. My Urological Surgeon consult appointment was booked for December 5th 2007, I received that appointment letter on October 17th 2007. Consult wait time was pretty much 2 months if the first request from Kenderdine would have been successful. My feeling is that I was 99% sure I was going to go for a vasectomy so I would have preferred just to have my surgery scheduled directly from the first request. Maybe even a quick phone conversation to brief me on the procedure and ensure that I wanted it. Dr. Jana did examine me to ensure he could perform the procedure on me but how many times does it happen that it's not possible to do the surgery?

    I would suggest that I could have had a shorter wait time if I had been scheduled for the procedure right away.

    Dr. Jana told me the likely wait time for my vasectomy would be 3 to 4 months from the December 5th consult date.

    It's my opinion that waiting 2.5 months for a consult appointment is excessive then waiting another 3 to 4 months for the surgery is excessive.

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