Posted on Wednesday May 11 2016 by RIG Healthcare
Pathology and radiology investigations provide essential information in the diagnoses of disease; confirm of the absence or stability of a disease process and help to measure the progress, treatment or recovery of our clients. In a community healthcare environment, diagnostic information can also guide our understanding to why we may observe signs and symptoms that our patients experience.
I would like to share some stories from my practice in community rehabilitation. These are situations where being without access to diagnostic information contributed to making poor decisions with my patients about their treatment and care.
No diagnostic information can lead to incorrect clinical judgement
I know from my own practice, I have hypothesised incorrectly due to not having an awareness of a patient’s pathology results. I can recall mistaking a client for being cognitively impaired when they were suffering from an acute delirium, due to a prolonged, untreated urinary tract infection.
No diagnostic information can lead to poor treatment planning
I know from my own practice, I have developed inappropriate treatment plans due to not having visibility of the investigations that were carried out in a hospital admission. I can recall subjecting a client to an intensive rehab’ programme and then observing their pain worsen and mobility deteriorate because I was not informed they had a pelvic fracture.
No diagnostic information can lead to inappropriate discharge planning
I know from my own practice, I have made poor decisions in my discharge planning due to not having access to a patient’s up-to-date pathology results. I can recall discharging a client early into their programme because of poor motivation and limited progress. I was later informed the client’s haemoglobin levels were very low and this was the cause of their lethargy and reduced ability to participate in the service I was offering.
At a community healthcare trust, I have been spending time with services that make pathology requests in their daily practice. The clinicians have shared many frustrating stories about the time they spend chasing labs or GP practices to share diagnostic results. Limited access to this information has caused delays in progressing patient assessments, intervention planning and treatments in the community settings.
At present I am working with an Interoperability Programme that has been trying to help overcome these issues. Interoperability is the ability of two or more systems, devices and/or products exchanging information and then using the information that has been exchanged. We have been working on an exciting solution with acute hospital laboratories, commission groups, clinical systems teams and clinical leaders to enable access to shared diagnostic information via an electronic patient record system.
The integrated platform being rollout is cloud based and can be used to electronically request a multitude of pathology tests. It also facilitates access to the wider diagnostic records held across acute and primary care services. For the first time, the community clinicians at this trust have a joined up diagnostic record system. Use of the platform has demonstrated that making electronic requests can greatly improve the time taken to receive results and that having accessing to existing diagnostic records is beneficial to clinical reasoning.
Thinking back to my own practice and the earlier reflections, if I had access to shared patient diagnostic results, it would have provided me with a more complete patient history. Having timely access to diagnostic information would have ensured I was more informed to be able to make better clinical decisions.
I believe the most powerful tool you can give a clinician is information. Accurate, up-to-date, and at the point of care information. I feel that providing community clinicians with diagnostic information is another step forward to achieving this.
Occupational Therapist / Interoperability Change Manager / Director of OTTech Healthcare Consultancy
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