How safe are your patients from falling through the cracks because of inadequate tickler, recall, or tracking systems? This is a big concern as patients in many cases are not safe and do fall through the cracks. You can call the systems a variety of names such as tickler, recall, or tracking, but they’re all methods of follow-up that are lacking or inadequate for many situations. Below are a few scenarios for you to evaluate your systems to prevent patients from being lost to follow-up.
- Many practices have some high risk patients. Would you know if a high risk patient needing ongoing monitoring of diabetes or high blood pressure failed to follow up within an ordered one-month period though the appointment was scheduled at checkout, but then rescheduled or canceled and the time frame was now far beyond the original one-month period?
- A treatment plan frequently includes a return appointment. When the patient schedules it at the time of checkout, the ability to promote patient safety with continuous monitoring of health status becomes more trackable. However, what if the patient declines to schedule and agrees to call and schedule within the specified time frame yet never calls? What system exists for the office to initiate the call to prevent the patient from being lost to follow-up? It is important for the physician to communicate a clear plan, preferably in writing, for schedulers to follow and easily identify the reason for the next visit.
- How would you know if there are outstanding diagnostic test results or specialist consult reports, especially when an authorization is not needed? The authorization process facilitates tracking for approval or denial, but is not always required and, therefore, an additional system should be maintained.
Several situations may be present that impede the tracking process, such as:
- The patient was compliant but the specialist or testing facility failed to send the results.
- The patient was compliant and the specialist or testing facility sent the results, but a breakdown occurred and they were never received.
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The patient was noncompliant and therefore the results will remain outstanding. This may happen when the patient:
- Fails to understand the plan.
- Changes providers who are unaware of the previous plan.
- Experiences financial hardship and is concerned about inability to pay for anticipated charges.
- Does not provide an explanation/unknown reasons.
In each of these examples, continuous monitoring of outstanding results enables physician involvement with follow-up to determine the best plan for preventing the patient from falling through the cracks.
When a treatment plan includes follow-up appointments, diagnostic tests, or specialist consults, the responsibility for follow-up to close the loop lies with the ordering provider. A tracking system should incorporate the following concepts:
- Is a tickler system such as computer spreadsheets, electronic health record task or tracking modules/features, or paper logs maintained to enable continuous monitoring?
- Is your system comprehensive for tracking the needs of your patient population?
- Who is responsible for monitoring outstanding orders?
- How is the outstanding/incomplete treatment plan communicated/coordinated with the ordering provider?
- What action will be taken for patient follow-up?
Designing and maintaining a tickler, recall, or tracking system for patient follow-up will help reduce risk, maximize patient safety, and promote optimal health status.
Jackie Gellis is a Senior Risk Management and Patient Safety Specialist for the Cooperative of American Physicians. Questions or comments related to this article should be directed to jgellis@CAPphysicians.com. This information should not be considered legal advice applicable to a specific situation. Legal guidance for individual matters should be obtained from a retained attorney.