Communication/reporting by referral centres

Re: Communication/reporting by referral centres

Utlendigur — Fri, 28 Mar 2014 20:44:47 GMT

Off topic but made me laugh. I referred a case to one of our regular referral centres this evening using their on-line referral form, but accidentally missed selecting an option in the box asking whether the pet was male or female. Pressed "submit form" only to get a pop-up saying

"......... Referrals says sex? (please select)"

Re: Communication/reporting by referral centres

karen jones — Fri, 28 Mar 2014 20:33:41 GMT

[quote user="David Shepherd"]

[quote user="Neil Wheadon"]

[quote user="David Shepherd"]On a similar but different note; I have a major gripe with AHVLA vets not communicating about TB breakdowns[/quote]

In what respect?

Interpretation

Epidaemeological groups

Spoligotypes

The list goes on

A lot of letters are cc'd to the local practice including NVL and VL data and culture results.

. They are all contactable by e mail and my mobile number was in several partners phones and we would frequently discuss clients, many times after an OV had found an initial breakdown. There are about 100 ongoing cases per vet, and testing can be every 2 months and they are expected to do other things too. It's a 2 way process

Neil (left AHVLA 30 months ago)

[/quote]

Slight thread drift here, but all of the above. One recent incidence where a client had a slaughterhouse case, followed by repeated tests by AHVLA, including blood tests (we are in an 'edge' area) with absolutely no contact to the practice so far. The farm has now appeared on our Sam list for a SI test so presumably we have now to carry on managing the case.

Your modus operandi was obviously very different from the AHVLA vets we deal with; not helped by having to deal with at least 3 different regions plus the other specialist offices. I have no means of finding emails or phone nos for case vets; even the office contact email on the website is often not answered. It sometimes seems that AHVLA go out of their way to prevent it being a 2-way process.

Unfortunately, unlike the situation with referral centres, we have no option to take our business elsewhere.

David

[/quote] We are on Shropshire /welsh border and find that if the farmer in Wales ticks the box to receive his communications in Welsh then we also get all information for that farm (reports on slaughter house cases, pm of reactors etc) in Welsh with no English translation. Apparently the Welsh animal health can't send us it in English if the farmer his communication in Welsh. I have very basic Welsh but some of these documents can't be easily translated by our Welsh speaking staff. We then have to tackle the switch board in Caernarfon

Re: Communication/reporting by referral centres

Nicola Cole — Fri, 28 Mar 2014 19:46:17 GMT

I've always had very good experiences with referral centres. Before I moved house and areas I had a lovely private small animal referral centre on my doorstep-fantastic clinicians, would ring with updates, faxed discharge letters on day of discharge, happy to discuss cases/view radiographs even if no chance of it being a referral, if more limited finances would advise appropriately, if something else was noticed whilst at the referral centre they would ring to ask permission to work up that condition etc. The referral centre I mainly use at moment is a university and also have been really good.

Re: Communication/reporting by referral centres

Neil Wheadon — Fri, 28 Mar 2014 18:32:46 GMT

I see no reason not to comment here as may help both you and the farmer.

There would have been a DRF (Disease Report Form) done at an early stage, though if the SLH case was less than 3 years from the last outbreak it might not have been a priority. Having said that if gamma testing was done then someone would have been involved. I'd start by asking the farmer who came to see him and this will give you a lead. I'm not sure how your area is organised but the South West had geographical vets to provide local knowledge, but with closure of centres this became difficult. There may also have been some risk assessement and splitting of epidaemeological groups (I was really keen to do this as reduced the testing burden and cost to everyone considerably - TB doesn't affect the whole herd and faecal transmittion has never been proved) so if there was, someone did this. I can't quite see why it should be difficult, there are some very good vets within AHVLA who put the farmer first, hopefully you'll find one.

Neil

Re: Communication/reporting by referral centres

David Shepherd — Fri, 28 Mar 2014 17:55:30 GMT

[quote user="Neil Wheadon"]

[quote user="David Shepherd"]On a similar but different note; I have a major gripe with AHVLA vets not communicating about TB breakdowns[/quote]

In what respect?

Interpretation

Epidaemeological groups

Spoligotypes

The list goes on

A lot of letters are cc'd to the local practice including NVL and VL data and culture results.

Neil (left AHVLA 30 months ago)

[/quote]

Unfortunately, unlike the situation with referral centres, we have no option to take our business elsewhere.

David

Re: Communication/reporting by referral centres

Anthony Dennison — Fri, 28 Mar 2014 14:48:33 GMT

[quote user="Robin Grimmer"]To turn it around, how many of you write a proper referral letter when you refer a case?[/quote]

Always. I find it makes the case stand out a bit more. Also because our history print outs are such poor quality I feel I have to write everything down. I can also add in more of my personal opinion than I can on a patient's records.

If I was the specialist I'd like to be informed as possible.

Re: Communication/reporting by referral centres

Wren — Fri, 28 Mar 2014 12:15:23 GMT

[quote user="Malcolm Ness"]

We try very hard to keep all interested parties, including and especially, the referring clinician "in the loop". To that end our receptionists fax or email the referring practice as soon as the client arrives with us then the attending vet writes a report within 24hrs of treatment. If things are moving fast, then we will often telephone the referring vet with an update.

[/quote]

In the dim and distant past when I used to do some SA work I did indeed refer cases to you. Your reporting and 'keeping in the loop' was excellent.

Re: Communication/reporting by referral centres

Wren — Fri, 28 Mar 2014 12:13:13 GMT

[quote user="grumpyoldman"]

1.its not your business , its the clients or their insurers who are also probably chomping at the bit demanding blow by blow accounts . [/quote]

Actually, it is my business! They are obliged (as per the quoted bit from the GTPC earlier in the thread) to share the clinical details with me when they treat a patient under my primary care. The clients are usually there with the animal, so know what's going on, or are kept pretty well informed.

[quote]

2. you could always invest more in equipment and CPD and refer less and do more yourself ?. [/quote]

That's a tricky one. We're ambulatory equine vets. To undertake surgery would mean acquiring suitable premises, kitting them out with sevearl hundred thousand-worth of kit, staffing them 24/7 (you generally need at least 2 vets and 2 nurses to carry out laparotomoies - that's a lot of staff on a rota to make sure that there are that number available on call at all times), we'd need to learn the expertise involved (which would probably take months or years), run a hosptial to care for the post-op patients. It kind of seems like an awful lot of investment when there are at least 4 centres doing this already within a couple of hours of here...

Re: Communication/reporting by referral centres

Wren — Fri, 28 Mar 2014 12:04:22 GMT

[quote user="Robin Grimmer"]

To turn it around, how many of you write a proper referral letter when you refer a case? Our nearest referral centres are great. The large, well known one will accept almost anything at short notice, sends a prompt update and discharge instructions and will give us advice on any case. The other one doesn't have such a high level of specialist, but are very good on orthopaedics, and much cheaper when cost is a concern.

[/quote]

Rarely, because with horses most of our referrals are for emergency surgery - either colics (which are often in the middle of the night), serious injuries, unresolvable chokes, that sort of thing. Usually the client is boxing the horse up to leave as I'm on the phone arranging the referral. As such there is rarely much history (and if there is I will of course fax/email it) beyond what injections I have given pre-transport to stabilise it and of course clinical parameters on first exam. These are usually given verbally to the referral vet over the phone.

For anything that goes for a chronic condition with an appointment in advance I will email over the relevant history together with my thoughts and a copy of any rads/scans etc.

Re: Communication/reporting by referral centres

Dagmar Steele — Fri, 28 Mar 2014 10:23:52 GMT

Of course this is a two way street. Hence I always send an email before client arrives. I now do it on the day of their appointment or the day before because if done too early these emails have the tendency to vanish at the referral centre. If it's really urgent and I don't find the time to write now and then, I ring them up and write later. Occurs very rarely as usual referral isn't because of a true emergency but because of further investigations or procedures necessary.

Re: Communication/reporting by referral centres

Malcolm Ness — Fri, 28 Mar 2014 10:14:08 GMT

Sometimes we fail. My memory has never been perfect and it is not ageing well. Other times we get blamed for failing when we have telephoned repeatedly to be told that the vet is too busy to come to the phone and the referral report that we have written and sent in a timely fashion "fails to arrive". However, usually the process works well and to the benefit of all parties. It is obvious to the less arrogant contributors on this thread that referral is a two way street and I find it mildly amusing that a cohort of practitioners feel free to malign referral clinicians in a way that would cause uproar if the tables were turned.

Despite what others have said, it emphatically IS your business.

Re: Communication/reporting by referral centres

grumpyoldman — Fri, 28 Mar 2014 00:06:09 GMT

[quote user="Wren"]Am I expecting too much, has common courtesy gone out the window or are these centres so busy that they can afford to lose my business?[/quote]

1.its not your business , its the clients or their insurers who are also probably chomping at the bit demanding blow by blow accounts .

2. you could always invest more in equipment and CPD and refer less and do more yourself ?.

3. I refer rarely if at all and its usually to get rid of difficult clients with unreasonable expectations, nosey parker friends or relatives ,or some fool on a radio phone in sticking his oar in sideways, I find its fine for insured people who want everything possible ,but for the rest it rarely changes the outcome, confirms the diagnosis prior to the inevitable. I have also had some bad experiences with unsuccessful orthopaedic interventions inappropriate medical management of surgical cases, prior to asset stripping the pet plan then dropping it back in my lap anyway. I remember one case recently with a chylothorax we did some radiology and a tap ,referred it for surgery with 3.5k left on its policy , they spent 2.5k confirming it was indeed a chylothorax before sending it back saying the client could not afford the surgery because it was under-insured!!!. So I ended up doing it anyway,to keep the by now really pissed off client happy for £750. It filled an hour on a wednesday afternoon.

4. No its not unusual to hear nothing for days then just get a letter or a fax.

5. I never thought there was a great deal of common courtesy .

Re: Communication/reporting by referral centres

Robin Grimmer — Thu, 27 Mar 2014 22:58:42 GMT

Re: Communication/reporting by referral centres

Rob Loxley — Thu, 27 Mar 2014 22:29:39 GMT

[quote user="Martin Atkinson"]I find the larger private referral centres are worst for this, the one man bands and universities are generally much better[/quote]

I'm not sure - the private referral centres often understand better that they need to give a good service to the referring vet (as well as the client/animal) than the universities. I think it also comes down to the people - we deal with a few multi-disciplinary centres and will refer medicine and soft tissue cases to one and ortho elsewhere and eyes to a third place, as we have good experience/relationships with the relevant people

Re: Communication/reporting by referral centres

Dagmar Steele — Thu, 27 Mar 2014 14:52:59 GMT

I admit this affects my choice of referral centre as well. I have wrestled with the local very good referral centre over this issue for some time but now we are where I want to be: They tell me about the patient being there, first dx and tx and I get a full report when discharged as well as a heads up if thing change considerably somewhere down the line. Every now and then standards drop and I need to complain a bit ;-)

Re: Communication/reporting by referral centres

Hannah Wynne Richards — Thu, 27 Mar 2014 14:50:54 GMT

I agree with Utlendigur - either very good or very bad.

Wynne

Re: Communication/reporting by referral centres

Martin Atkinson — Thu, 27 Mar 2014 14:43:22 GMT

[quote user="patrick murphy"]

it greatly affects my choice of centres. I have had the supermarket experience of a PTS that I was totally unaware of. once my own horse was opened up for a second time without even consulting me.

[/quote] I have had several instances of referring just for a diagnosis then the referral centre performed surgery which I was perfectly capable of doing myself without informing me. Worse than that was a case that was referred for one condition then re-referred to another specialist within the same group for a separate condition I was already treating without informing me or asking me for a history. That is surely as much supersession without the knowledge of the previous vet as the practice down the road pinching cases without asking and against RCVS rules. I find the larger private referral centres are worst for this, the one man bands and universities are generally much better but it also depends on the individual clinician and what sort of rapport I have with them. Although there is one small exotic referral practice in West London that never reports back on referrals and also takes patients without referral or history!! Shame on you all.

Re: Communication/reporting by referral centres

Utlendigur — Thu, 27 Mar 2014 14:19:27 GMT

Referral centres do seem to fall into two distinct camps. We've got 2 or 3 that are really good at keeping us informed and sending out reports when the animal is discharged, aswell as being approachable and available if we have a query (are we allowed to name them?). There are another two who are not. One of these I made the mistake of referring my own dog to. I was asked to redo bloods after a change in treatment but didn't hear anything back after faxing results, so I phoned - to be told both the internal medicine specialists were off and someone would phone me "in a week" (for a seriously ill case). That and other issues with previous cases - means I simply will not refer anything to them again. We also have a referral surgeon who visits a local practice but again I'm not keen to refer to him because of the two cases I've referred, I'm still waiting for a referral report for one 18months down the line despite several requests (I'd actually like to know what surgery was done, since the owners aren't sure!) and with the other, the client decided not to proceed but I don't even know whether he saw the dog or not as I had zero feedback. It also helps to get an acknowledgement that the referral has been received or an appointment made - even if it's just an automatic email receipt or call from the reception.

Re: Communication/reporting by referral centres

patrick murphy — Thu, 27 Mar 2014 14:00:20 GMT

it greatly affects my choice of centres. I have had the supermarket experience of a PTS that I was totally unaware of. once my own horse was opened up for a second time without even consulting me.

Re: Communication/reporting by referral centres

Neil Wheadon — Thu, 27 Mar 2014 13:54:15 GMT

[quote user="David Shepherd"]On a similar but different note; I have a major gripe with AHVLA vets not communicating about TB breakdowns[/quote]

In what respect?

Interpretation

Epidaemeological groups

Spoligotypes

The list goes on

A lot of letters are cc'd to the local practice including NVL and VL data and culture results.

Neil (left AHVLA 30 months ago)

Re: Communication/reporting by referral centres

Wren — Thu, 27 Mar 2014 13:48:03 GMT

[quote user="Andrew Kent"]

it's also much easier if you can give an email address for updates as getting though to people on the phone (at both ends) is challenging.

[/quote]

Not too bad for me, as an ambulatory equine vet I've pretty much got my phone on me 24/7 and it's rare that I can't answer. Phone calls are usually welcome to break up the tedium of driving!

An email would be great. Heck, a carrier pigeon would be great. STILL waiting to hear about Monday's referral, despite having finally (I think) persuaded the reception team that they are permitted to share the information with me and having left an office number, mobile number and email address. Apart from anything else with things like colics (which this case wasn't) it's important to get the feedback to improve your diagnostic skills. If someone confirms that the horse you sent in with what you though was a nephrosplenic entrapment actually was one, then you can add it to your information bank for next time.

Re: Communication/reporting by referral centres

Andrew Kent — Thu, 27 Mar 2014 13:39:36 GMT

Hi All,

I agree that the examples you give are unacceptable and, as somebody who now works in referral practice, I aim to update the referring vet on the day of discharge with interim reports if hospitalisation is prolonged.

however, i do find an enormous variation in how interested referring vets are in keeping up with their cases. Some vets want daily updates, some vets don't really want anything, and most people are somewhere in between those two extremes. But, unless you let the centre know your expectations it is difficult for them to comply. So speak to them.

it's also much easier if you can give an email address for updates as getting though to people on the phone (at both ends) is challenging.

Andy

Re: Communication/reporting by referral centres

David Shepherd — Thu, 27 Mar 2014 13:12:24 GMT

RCVS guide to Professional Conduct;

Mutual clients

5.7 Where different veterinary surgeons are treating the same animal, or group of animals, each should keep the other informed of any relevant clinical information, so as to avoid any danger that might arise from conflicting advice, or adverse reactions arising from unsuitable combinations of medicines.

Report them to RCVS Profcon.

On a similar but different note; I have a major gripe with AHVLA vets not communicating about TB breakdowns. I have made some initial contact with Profcon at RCVS but not holding my breath

David

Re: Communication/reporting by referral centres

Neil Wheadon — Thu, 27 Mar 2014 13:11:43 GMT

I referred a case to Rowe in Bristol to the dermatologist

She called from Italy initially and I'm still getting regular updates with letters, even though I only locummed for the referring practice for 2 weeks.

Beats most CPD providers as the client is paying for my increased knowledge of atopy

Neil

Re: Communication/reporting by referral centres

Bob Russell — Thu, 27 Mar 2014 13:01:35 GMT

Can be an annoyance. We do hear back from the owners before the referral centre on a regular basis. I know it takes time to do reports etc but a quick email to say, seen, ultrasound, CT admitted and settled would be nice. They are really good at communicating with owners!

They are getting better! I am not expecting an essay and not asking for details, just enough to keep us in the loop and not to look blankly at the owners when they walk in the door!

A grumble not a complaint and they are really very good and it has been discussed at length!