Referral writing: Consensus building on a tool for writing structured referrals

Competency in referral writing skill is needed by doctors for which they are never trained. Although there is a lot of work done about improvement of consultation letters still priority is not given. There must be a course for teaching and learning medical referral writing skills to students along with the assessment. Currently there is such tool to assess the way communication letter are written. An 18-point assessment scale has been developed through Delphi technique to increase the quality of referral letters. The objective of the present study was to design a structured Performa for writing referrals, validated by 7 participants using Delphi. Results were finalised after the acceptance of structured referral by selected participants through Delphi. The response rate was 70%. The validity and interrater reliability were calculated using SPSS25. The Cronbach’s alpha was 0.7 and Kappa was 0.3. Both were statistically significant. The designed Performa for writing referrals, with its inter-rater reliability calculated, is best for writing effective and structured referrals. The study further recommending training junior doctors in making proper referrals. MeSH Words: Referral and consultation, improving quality and referral, Checklists and referrals and consultation.

Reflecting on Palliative Care Integration in Canada: A Qualitative Report

Studies have identified integrated interdisciplinary care as a hallmark of effective palliative care. Although models attempt to show how integration may function, there is little literature available that practically explores how integration is fostered and maintained. In this study we asked palliative care clinicians across Canada to comment on how services are integrated across the healthcare system. This is an analysis of qualitative data from a larger study, wherein clinicians provided written responses regarding their experiences. Content analysis was used to identify response categories. Clinicians (n = 14) included physicians, a nurse and a social worker from six provinces. They identified the benefits of formalized relationships and collaboration pathways with other services to streamline referral and consultation. Clinicians perceived a need for better training of residents and primary care physicians in the community and more acceptance, shared understanding, and referrals. Clinicians also described integrating well with oncology departments. Lastly, clinicians considered integration a complex process with departmental, provincial, and national involvement. The needs and strengths identified by the clinicians mirror the qualities of successfully integrated palliative care programs globally and highlight specific areas in policy, education, practice, and research that could benefit those in Canada.

Mild cranioencephalic trauma in the child population. Experience at the Baca Ortiz Hospital, Quito-Ecuador, 2016-2019

Introduction: The alteration at the anatomical and/or functional level, both motors, sensory and cognitive, a product of the sudden exchange of mechanical energy caused by an external force on the skull, is what defines a traumatic brain injury (TBI). The permanence or transience of these alterations determines the severity of the TBI, with 70 to 80% of a mild type whose neurological symptoms are of little intensity and duration. Clinical observation in mild TBI includes observing children under 2 years of age with trauma without fracture or admission criteria clinically for 2 to 4 hours and observing children with symptoms or mechanism of fall for 4 to 6 hours not known. The objective of the study is to describe mild TBI at Baca Ortiz Pediatric Hospital, a national children's referral hospital in Ecuador, during the period from January 2016 to December 2019. Methods: Cross-sectional, descriptive, and retrospective study that includes patients diagnosed with mild head trauma evaluated and treated in the Neurosurgery Service of the Baca Ortiz Pediatric Hospital, from January 2016 to December 2019. Results: During the period 2016 to 2019, 105 children with mild TBI were diagnosed and treated, this being more frequent in males (62.85%) and during the preschool stage (51.42%). Of all of them, 82.85% received specialty medical care in the first 6 hours after the trauma. The main etiology was the fall produced at home (66.66%). Conclusions: Mild traumatic brain injury is one of the main reasons for pediatric hospital consultation in our setting. It mostly occurs in male patients of preschool age, because of falls at home. Keywords: Craniocerebral Trauma, Child, Hospitals, Pediatric, Referral and Consultation (Source: MeSH NLM)

Hostile media reporting and its effect on patient management behaviour of doctors who have not faced workplace violence

Media finds doctors as a soft target for all sorts of healthcare system failure. The hostile media reporting has demonized the medical profession and has forced doctors to adopt a more reserved attitude. The present study focuses on assessing the effect of media on patient management by the doctors who had not faced violence at the workplace. It was observed that as a consequence of unfavorable media reporting, prescribing of investigations, and referral and consultation liaison increased, whereas, handling of complicated cases by the doctors decreased. Therefore, even the doctors who have not faced any workplace violence are influenced by news of workplace violence against doctors and are adopting safer strategies in the management of patients.

Awareness of Ototoxicity among Medical Doctors in Assam

Introduction Previous literature has reported ill-effect of ototoxic drug on hearing and balance. Present study investigated awareness among medical doctors for the same. Method A total of 55-medical doctors of multiple specialties from Assam, India participated in the present study. A total of 14 questions with Likert Scale based scoring pattern were framed and validated for the present study. Results Outcome of the present study showed high awareness percentage about side effect ototoxic drugs was obtained, which was a satisfying outcome. Conclusion While low audiological referral and consultation awareness was identified as an area of concern.

Queensland Telepaediatric Service: A Review of the First 15 Years of Service

In November 2000, the Queensland Telepaediatric Service (QTS) was established in Brisbane, Australia, to support the delivery of telehealth services to patients and clinicians in regional and remote locations. The QTS was built on a centralized coordination model, where telehealth services could be effectively managed by a dedicated telehealth coordinator. In doing so, telehealth referral and consultation processes were efficient and clinicians felt better supported as they adjusted to new processes for engaging with patients. We have conducted a retrospective review of activity associated with the QTS and summarized key activities which have arisen from this extensive program of work. Telehealth service records and associated publications were used to describe the evolution of the QTS over a 15-year period. From November 2000 to March 2016, 23,054 telehealth consultations were delivered for 37 pediatric clinical specialties. The most common service areas included child and youth mental health, neurology, burns care, surgery, and ear nose and throat services. A range of different telehealth service models were developed to align with different clinical service needs and location of services. Whilst most work involved video consultation between hospitals, some services involved the delivery of telehealth services into the home, schools or community health centres. Despite its longevity, the QTS was not immune to the usual challenges associated with telehealth implementation, service redesign and sustainability. Experience reported from the QTS will be useful for other health services seeking to develop comprehensive telehealth services in a rapidly changing healthcare environment.

Nurse practitioners and physician assistants working in ambulance care: A systematic review

Background: This review aims to describe the activities of nurse practitioners (NPs) and physician assistants (PAs) working in ambulance care, and the effect of these activities on patient outcomes, process of care, provider outcomes, and costs. Methods: PubMed, MEDLINE (EBSCO), EMBASE (OVID), Web of Science, the Cochrane Library (Cochrane Database of Systematic Review), CINAHL Plus, and the reference lists of the included articles were systematically searched in November 2019. All types of peer-reviewed designs on the three topics were included. Pairs of independent reviewers performed the selection process, the quality assessment, and the data extraction. Results: Four studies of moderate to poor quality were included. Activities in medical, communication and collaboration skills were found. The effects of these activities were found in process of care and resource use outcomes, focusing on non-conveyance rates, referral and consultation, on-scene time, or follow-up contact Conclusions: This review shows that there is limited evidence on activities of NPs and PAs in ambulance care. Results show that NPs and PAs in ambulance care perform activities that can be categorized into the Canadian Medical Education Directives for Specialists (CanMED) roles of Medical Expert, Communicator, and Collaborator. The effects of NPs and PAs are minimally reported in relation to process of care and resource use, focusing on non-conveyance rates, referral and consultation, on-scene time, or follow-up contact. No evidence on patient outcomes of the substitution of NPs and PAs in ambulance care exists. PROSPERO registration: CRD42017067505 (07/07/2017)