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.)