1. Lost in Transition Exploring continuity of care through HDC complaints

2. HDC vision: a consumer-centred system Consumer Centred System Engagement Seamless Service CultureTransparency

3. What do we mean by continuity of care ?

4. “…extent to which a series of healthcare services is perceived or experienced as connected and coherent and consistent with the health needs and personal circumstances of a patient” Haggarty et al. BMJ 2003; 327:1219-21

5. Continuity of Care Relational continuity Information continuity Management continuity Haggarty et al. BMJ 2003; 327:1219-21

6. Continuity of Care Relational continuity personal relationships between individual patients and professionals, built on shared experience and interpersonal trust.

7. Continuity of Care Management continuity services are delivered in a complementary and timely manner; plans protocols facilitate management continuity, providing a sense of predictability and security in future care for both patients and providers.

8. Continuity of Care Informational continuity how information is transmitted across time, across place of care, and across professional boundaries

9. Right 4(5) Right to Services of an Appropriate Standard Every consumer has the right to co-operation among providers to ensure quality and continuity of services.

10. 4. Right to have services provided 1) … with reasonable care and skill. 2) …that comply with legal, professional, ethical, and other relevant standards. 3) …in a manner consistent with his or her needs. 4) …in a manner that minimises the potential harm to, and optimises the quality of life of, that consumer.

11. Care, co-operation and communciation 93 year-old long-term resident Deterioration Lack of care Lack of informational continuity of care 09HDC01641

12. 09HDC1641 Right 4 (1) for care Right 4 (5) – communication between staff Lack of clarity of roles – not reading notes – communication with medical staff Lack of clarity about the system – documentation

13. Single provider (GP) Two consultations re bleeding, April and July November locum sends stool sample, no abnormalities December consultation agreement to refer for colonoscopy February goes to hospital in pain stage II cancerous tumour 10HDC00974

14. Forgets to send referral letter Did not use a computer reminder system Did not tell patient to let him know if no appt

15. 10HDC00974 Inadequate examinations at earlier appointments Inadequate systems for following up/alert on referral

16. Management of cardiology referral between DHB’s 09HDC01883

17. DHB 1 (respiratory) did not communicate effectively with DHB 2 − Right 4(5)

18. DHB 2 – (cardiology staff) did not obtain sufficient information in phone call did not seek a legible copy of the ETT results did not appropriately acknowledge the referral

19. Cauda equina - 10HDC00454 29 year-old woman R) sciatic pain ?disc prolapse GP consulted orthopaedic surgeon authorised CT scan GP – ordered CT – prescribed pain relief, anti-inflammatory – referred to CT scan

20. 10HDC00454 - GP should have ensured woman had timely specialist review, by: – Following up on fax and phone message to specialist – Impressing upon woman need for urgent review

21. 10HDC00454 - specialist Orthopaedic specialist should have tried to track the patient down

22. HDC vision: a consumer-centred system Consumer Centred System Engagement Seamless Service CultureTransparency