A collaborative study was conducted between Medisec and the University of Limerick Hospitals (UL) Group with healthcare professionals from primary care sites (GP practices and pharmacies) and secondary care sites as well as patients in both sectors.

The Steering Group included representatives from the State Claims Agency (SCA), Health Information and Quality Authority (HIQA), Irish College of General Practitioners (ICGP), School of Pharmacy Trinity College Dublin, Schools of Medicine: University of Limerick (UL) and University College Dublin (UCD), Medical Council, World Health Organisation (WHO) Patients For Patients’ Safety, Health Service Executive (HSE), UL Hospitals. The project was managed by an independent healthcare consultant.

Project overview

The main aim of this study was to investigate the experiences of clinical incidents in healthcare settings from the perspectives of both healthcare professionals and patients and determine key strategies for improving healthcare services and transitions in care.

Semi-structured interviews were conducted with healthcare professionals including GPs, pharmacists, consultants, hospital doctors, nurses and administration staff and a focus group with patients from primary and secondary care.

The report identified the following:

• Medication error was the most predominant risk highlighted among healthcare professionals
• Current referral pathways to hospital are complex. Conflicting views among healthcare professionals on appropriate referral routes were identified
• While most GPs are utilising IT based systems in their practices, paper based systems are still creating barriers in communication between primary and secondary care, and healthcare professionals in both sectors are receiving handwritten referral and discharge letters with limited and, in some cases, illegible patient information
• Healthcare professionals requested expansion of the role of the hospital pharmacist and increasing the number of hospital pharmacists at ward level
• Patients want to be empowered with access to their medical notes

Project Recommendations

The report recommends the following:

• In order to decrease the risk of medication error, electronic information sharing practices need to be synchronised across primary and secondary care
• The expansion of the role of the hospital pharmacist, increasing the number of hospital pharmacists at ward level and encouraging more collaboration with other healthcare professionals from primary and secondary care which could reduce the risk of medication error
• The need for clearer referral and discharge pathways and support for healthcare professionals in transitioning patients from primary and secondary care in terms of providing more resources in units such as the Acute Medical Assessment Unit (AMAU), Medical Assessment Unit (MAU) and the Local Injuries Unit (LIU)
• A long-term solution would involve synchronising IT systems across primary and secondary care and greater use of electronic communication, including the usage of “healthmail” which allows all hospitals to communicate clinical information securely to GPs
• Where possible, promote patient access to their own healthcare records, to promote patient inclusion in their own healthcare and to facilitate better patient communication, education and awareness

The objective of the steering group is to use the findings of the report to initiate improvements in the communication between primary and secondary healthcare sectors. There is continued collaboration of the agencies involved to action the recommendations identified.

Article by: Ruth Shipsey, CEO Medisec Ireland and Claire O’Regan, Clinical Risk Adviser, State Claims Agency