How do I ensure continuity of care during COVID disruptions?

28 April 2020

The challenges

COVID-19 has resulted in widespread disruption to the healthcare system. Elective procedures have been cancelled, referrals for radiological and other investigations have been delayed, and patients presenting to emergency departments for chest pains and other non-COVID symptoms have declined.

To reduce the risk of exposure to COVID-19, practitioners have altered the way they consult and treat patients, with consultations now widely occurring by telehealth and car park attendances. Reportedly some elderly and at risk patients are avoiding seeking treatment, and patients without the capability for telehealth are being disadvantaged by practitioners reducing in person consultations.

Despite the challenges, it is important that practitioners continue to provide appropriate patient care including by facilitating coordination and continuity of care for their patients.

Continuity of care

Good medical practice includes providing continuity of care for a patient. This occurs through:

  1. Consultations with patients, including ensuring maintaining adequate health records.
  2. The implementation of a treatment plan, including any required investigations.
  3. The review and action of tests and results, including protocols for follow-up.
  4. Ensuring the recall of a patient.
  5. Ensuring the appropriate transfer of a patient’s care.

If practitioners fail to take reasonable steps regarding continuity of care, patient care could be compromised resulting in adverse health outcomes and practitioners may as a result be exposed to medical negligence claims and/or regulatory complaints and notifications.

Practical tips

The disruption caused by COVID-19 may require a more proactive approach to aspects of patient care by practitioners, for example by ensuring appointments cancelled by vulnerable patients are re-scheduled. There are freely available resources for practitioners to utilise to help them with meeting their continuity of care obligations. Those resources include seeking assistance from administrative staff and practice managers with appropriate systems in place, from peers and from colleges and medical indemnity insurers. In addition to those, we provide the below practical tips and things to consider.

A responsive system for patient care

  • Implement or review systems for telehealth and technology-based consultations.
  • Get to know how the systems work, as well as their limitations. This will help you to determine the most appropriate system of care for each individual patient.
  • Inform your patients about the systems and procedures. Explain how their individual consultation will occur - remember, some patients may need more guidance and reassurance than others.
  • Be prepared. Make sure you have adequate supplies of personal protective equipment to allow safe in person consultations when necessary.
  • If in person consultations are limited, have a clear process for prioritising patients according to urgency of need or to refer patients to other practitioners who can appropriately prioritise them.
  • Arrange back up. If you are unable to provide treatment in a particular situation is there a colleague who can?

Ensuring continuous and comprehensive care

  • Document and keep up-to-date care plans, reviews, and health summaries in each patient’s health records. This is especially relevant for patients with complex or chronic health conditions that place them at particular risk due to COVID-19 or the disruption caused by COVID-19.
  • Remember the importance of clinical handover when a patient’s usual practitioner is unavailable.
  • Review patient lists to identify at risk patients and consider whether additional care and/or communication may be required for these individuals.
  • Review clinic policies and procedures for recalls and reminders. Are changes needed to respond to the likely increase in rescheduled and cancelled consultations?
  • Keep up to date with your network. Have the referrers, specialists, diagnostic services or after hours service providers that you ordinarily deal with had any disruptions to their operations? Where necessary identify alternatives so that patients are not subjected to unreasonable delays.
  • Ask if there is anything else. Some patients may be less forthcoming in a telehealth or carpark consultation than they would be in a normal appointment, resulting in missed opportunities to address other issues such as mental health concerns.
  • Where transfer of care is required, ensure that the patient is aware of all results and treatment plans and that an adequate handover of records occurs.

Follow-ups, recalls and reminders

  • Have processes in place to ensure that all results, recalls and reminders continue to be received and actioned in the event of disruption to your practice.
  • Consider a proactive approach to rescheduled and cancelled consultations, in particular in relation to elderly or vulnerable patients, mental health patients or regular patients with chronic conditions.
  • Review policies and procedures regarding how the practice notifies a patient of results and consider appropriate alternatives to communicate results to certain patients.
  • Ensure you have a robust system for reminders about surveillance or procedures, such as colonoscopies, that may be delayed beyond the usual wait times, to ensure that they are actioned.
  • When communicating significant or unexpected results to patients by telephone or via technology instead of in person, take particular care to ensure the patient understands the significance of the results and the further action needed.
  • Document all follow-up calls and attempts to reschedule appointments in the patient records.

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