Hidden Treasure

Last week, I attended 2 meetings that were goldmines. IHI’s Redesigning the Clinical Office Practice Summit and Taming of the Queue were high-yield for great ideas, both at the formal presentations and through informal discussions. While I was pleased to find out about some exciting quality improvement work being done across North America, I was a little annoyed that I only made these discoveries by virtue of attending the meetings.

For example, I’m interested in improving how information is shared between family doctors and specialists when a referral is made. At various meetings, I’ve happened on projects that are directly related to this area:

• Our hematuria referral information letter has improved the amount of information we receive, but a web-based referral system would be better. It turns out that Manitoba is already developing an electronic referral system that guides family doctors through the referral process.
• A Winnipeg radiologist reported on an electronic system to manage x-ray requests. Because of concerns that some x-rays may be ordered inappropriately, and not contribute significantly to patient care, the system provides decision support, based on clinical information entered by the physician. This is a potential educational tool that would give immediate feedback to a referring physician. Demand for consultation may be reduced if this feedback assists the physician in managing the patient’s condition in the primary care setting.
• A British Columbia physician showed me a template for specialists to list the appropriate investigations and information that should accompany a referral request. Specialists can indicate what tests should or should not (reducing unnecessary testing) be done.

It made me wonder how much other relevant QI work is going on under the radar. Are we missing opportunities for collaboration and reducing wasteful duplication? We need a central clearinghouse for quality improvement work being done across the country.