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Standards for general practices (4th edition)

including Interpretive guide for Aboriginal and Torres Strait Islander health services

Standard 1.1 Access to care

Our practice provides timely care and advice.

Criterion 1.1.2

Telephone and electronic communications

Patients of our practice are able to obtain timely advice or information related to their clinical care by telephone and electronic means (where in use) where a GP determines that this is clinically safe and that a face-to-face consultation is unnecessary for that patient.

Indicators

► A. Our practice team can demonstrate how we receive and return telephone and (if applicable) electronic messages from patients.

► B. For important communications, there is evidence of practice/ patient telephone or electronic advice and information in our patient health records.

C. Our practice's 'on hold' message (if we have one) provides advice to call 000 in case of an emergency.

Explanation

Key points

  • Practices need a policy about how they communicate with patients
  • Practices can communicate with their patients using electronic means
  • Practices need to advise patients about their policy on the use of electronic methods of communication, including limitations of use and any costs involved
  • All telephone callers being put on hold by practice staff should first be asked if the matter is an emergency
  • If the practice has an 'on hold' telephone message, it should include a message to 'phone 000 in an emergency'

Communications without compromise to quality care

While patients appreciate the ability to have access to a member of the clinical team by telephone or electronic means to discuss their care, the clinical team need to consider the quality and safety of care they can provide to patients via telephone or electronic means. It is acknowledged that practices can judge the appropriateness of individual communications and that full consultations cannot usually be conducted by telephone or electronic means.

Many practices provide the results of investigations to their patients by telephone. The person responsible for giving the results should ensure that the recipient of the advice is correctly identified using three patient identifiers so that patient confidentiality is not compromised. As outlined in Criterion 3.1.4 Patient identification, approved patient identifiers are those items of information accepted for use in patient identification and include:

  • patient name (family and given names)
  • date of birth
  • gender (as identified by the patient themselves)
  • address
  • patient record number where it exists.

General practitioners may wish to obtain advice from their medical defence organisation about the appropriateness of providing advice by telephone or electronic means.

Telephone and electronic equipment

The practice needs sufficient telephone and electronic equipment to support reliable and efficient communications.

Privacy and confidentiality

Some practices choose to communicate with patients using electronic means, such as email or SMS. Communication with patients via electronic means needs to be conducted with particular regard to the privacy and confidentiality of the patient's health information, since there is a higher risk of information inadvertently being seen by another person. It is recommended that practices consider whether it is appropriate to communicate particular information by electronic means or whether other methods would be more suitable (eg. for sensitive information such as HIV status or pregnancy results). It is also recommended that practices obtain documented patient consent before health information is communicated by email or SMS. Practices should cross check a patient's identification (using three approved patient identifiers) and verify the patient's contact details before any information is sent (see Criterion 3.1.4 Patient identification, Criterion 4.2.1 Confidentiality and privacy of health information and Criterion 4.2.2 Information security).

Practices need to have documented processes for ensuring that telephone and electronic messages from patients are recorded and given to the person for whom they are intended on the day of receipt, or in that person's absence, to the person who is caring for that absent team member's patients.

If the practice decides to provide patients with access to the practice by email, it is important that patients are made aware that their privacy and confidentiality may be compromised when communicating by email without encryption. Patients should also be made aware that only non urgent matters should be communicated by email, as opposed to telephone, as the practice team may not necessarily read all their emails on a daily basis. Similarly, information provided by the practice by email should be of a general nature when privacy is not assured. Information provided by fax may be even less secure when persons other than the patient may have access to the fax machine.

Referring important communications to GPs

Reception staff need to know which telephone calls should be transferred to GPs or to other staff who provide clinical care. It is recommended that GPs make time available in each session to take or return telephone calls. General practitioners and staff involved in clinical care need to make a record of all important contacts in the patient's health record. It is also important that staff are aware of individual GPs' policies on receiving telephone calls during consultations; ideally there will be a uniform system within the practice.

Peer reviewers need to take a common sense approach to the interpretation of the meaning of important communications.

Fees for telephone and electronic communications

Some practices may choose to charge a fee for telephone or electronic communication. Whenever a fee is charged, patients should be made aware of this and information about the costs of telephone/electronic consultations must be readily available as outlined in Criterion 1.2.4 Costs associated with care initiated by the practice. A frequent complaint from consumers is that they were unaware of the potential for costs when they telephoned a practice for advice outside normal opening hours.

Communications for patients with special needs

General practitioners and practice staff need to be aware of alternative modes of communication used by their patients, including those with a disability. Examples include the National Relay Service (NRS) for patients who are deaf and the Translation and Interpreter Service (TIS) for patients from a non-English speaking background. For further information about the NRS see www.relayservice.com.au and for TIS see www.immi.gov.au/living-in-australia/help-with-english.

Standard 1.1 Access to care

Our practice provides timely care and advice.

Criterion 1.1.2

Telephone and electronic communications

Patients of our practice are able to obtain timely advice or information related to their clinical care by telephone and electronic means (where in use) where a GP determines that this is clinically safe and that a face-to-face consultation is unnecessary for that patient.

In a nutshell

Your health service may give information or provide advice regarding clinical care to patients over the telephone or by electronic means. Your service needs to decide what information can be given to patients in this way, and by which staff members. This criterion is about providing good quality information when it is safe to do so.

Key team members

  • Reception staff
  • Clinical staff
  • Clinical leaders
  • Administration

Key organisational functions

  • Internal and external communications policies
  • Triage protocols and staff training
  • Patient confidentiality and privacy
  • Patient health records policy and procedures
  • Clinical risk-management systems
  • Patient information management systems and processes
  • Patient identification policy and procedure

Indicators and what they mean

Table 1.2 explains each of the indicators for this criterion. Refer to Criterion 1.1.2 Telephone and electronic communications of the Standards for general practices for explanations of some of the concepts referred to in this criterion. 

Table 1.2 Criterion 1.1.2 Telephone and electronic communications
IndicatorsWhat this means and handy hints
▶ A. Our practice team can demonstrate how we receive and return telephone and (if applicable) electronic messages from patients. Your service has policies or procedures in place that clearly set out:
  • the kind of information and advice that can be given to patients over the phone or electronically. This is usually information such as confirming appointment times or passing on simple messages from the doctor
  • the kind of information and advice that cannot be given over the phone or electronically. This is usually more sensitive information such as STI and HIV test results, pregnancy results or test results that need to be explained by a doctor
  • a method for reception staff to know how to receive patient phone calls, which ones they need to transfer to a doctor, nurse, Aboriginal health worker (AHW) or other staff, and how (and where) to record messages and pass them onto the doctor, nurse, AHW or other staff
  • a method for identifying patients over the phone that guarantees the information is provided to the right person. This usually includes three different personal questions about the patient (see definition of patient identifiers in Standard 1.6). Your service may also have a way to identify family members who have permission from the patient to receive information about them. A method for finding out who has been given permission and how to identify that family member could also be included
  • an email policy to ensure patients are told of the risk to their confidentiality when using email to communicate with the service. Patients can also be told how often you check emails, and the best way to contact the service for urgent matters. The policy could also clearly state the situations in which email can be used to give information and advice to patients because, even when encrypted, it poses a higher risk to confidentiality than other forms of communication – especially because there is no way of identifying the person receiving the email.
▶ B. For important communications, there is evidence of practice/patient telephone or electronic advice and information in our patient health records. Staff who have responsibility for giving important clinical information and advice to patients by phone or email are trained to write that information in patient health records. This could include the time and date the information is given as well as the kind of information that was provided.

It is also recommended that doctors and clinical staff get permission from patients who would like to receive clinical information and advice by phone or email, and that this is recorded in the patient’s health record. When giving their permission, patients could also be told of any fees and costs they may be charged. This can be done via a printed handout written in simple language that explains the charges and costs. If there are no fees for services, this is also stated clearly.
▶  C. Our practice’s on-hold message (if we have one) provides advice to call 000 in case of an emergency. Your service gives advice to call 000 to patients who are put on hold so that they have an alternative way of getting urgent medical attention and advice if needed. If necessary your service gives this advice in community languages.

Case study

Below is a description of the ways in which an Aboriginal community controlled health service can ensure its patients are able to obtain timely advice or information about their clinical care, when appropriate, by telephone or electronic means. Not all of these good practices are required by the Standards, but they illustrate the many practical and creative things that ACCHSs can do to ensure they deliver services of high safety and quality to their community.

The service has a system in place to ensure that current phone numbers and an alternative contact for patients are available to staff. It also has a paper-based and/or electronic messaging system. The doctors return phone calls after lunch before seeing the next lot of patients.

The reception area has a list for each doctor, detailing who will be allowed to interrupt them while they are seeing a patient. For example, Dr Best will only take phone calls from other doctors or the local hospital emergency department staff but Dr Practice will take phone calls from other doctors, specific patients he has been trying to contact, pharmacists and Royal Flying Doctor Service staff members.

The service has a set protocol for switching the answering machine system on and checking that the message is correct at the end of each day.

Staff members ask patients their name, address and date of birth (if known) before giving any information over the phone. Sometimes the staff also ask for patients’ skin name if they have one.

Staff members make a note in patients’ health files when they receive a phone call from, or make a phone call to, patients about clinical matters. Staff also record any advice or information they have given to patients and if they have made an appointment to see patients face to face.

Patients’ files will contain a note if the patient has given staff consent to contact someone else on their behalf.

Staff members’ training logs show attendance at a privacy and confidentiality training session.

Showing how you meet Criterion 1.1.2

Below are some of the ways in which an Aboriginal community controlled health service might choose to demonstrate how it meets the requirements of this criterion for accreditation against the Standards. Please use the following as examples only, because your service may choose other, better-suited, forms of evidence to show how it meets the criterion.

  • Maintain a paper-based messaging system.
  • Maintain an electronic messaging system (email, SMS texts, voicemail and messages).
  • Ensure reception staff can demonstrate that they know which phone calls need to be transferred to doctors or other staff who provide healthcare for patients.
  • Ensure the appointments book shows that doctors, nurses and other clinical staff have time set aside during the day for returning phone calls to patients.
  • Keep a policy, procedure or flow chart showing how to deal with phone calls from patients.
  • Ensure that patients’ health records show entries of when staff members talked about clinical matters to patients either by phone or email.
  • Take notes that show when patients called, their reason for calling and what advice they were given.
  • Ensure that when someone rings your service and is placed on hold they will hear a message advising them to hang up and call 000 in case of an emergency.
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