Liaison News

Otago
General Practitioners

Issue 27 – May 2011

What’s New
x Survey of iSoft Registration
x Discharge Letters
x Cardiac ECHO/ Urology
x Pain Clinic
x Department News/ TIA Pathway / Website
x Public Oral Health / Medical Council Meeting

ISOFT REGISTRATION
Thank you to all the practices that completed the survey sent recently by the Southern
PHO regarding your individual practice’s use of iSoft (the Dunedin hospital IT product)
that allows you to view clinical information about your patients as they have interaction
with the hospital.
One practice in greater Dunedin and fourteen in rural Otago have not yet registered.
If you don’t already have access, please contact me for more information.
anne.worsnop@southerndhb.govt.nz
However, in the survey a few other topics were mentioned and I will answer those:

ED DISCHARGE LETTERS NOT AVAILABLE ON ISOFT –

By the end of 2011, ED letters should be available on iSoft as soon as the patient has
been discharged – apparently it is starting in June 2011 with a following 3months of
installation!

THE ABILITY TO VIEW XRAYS ON OUR PRACTICE COMPUTERS THROUGH PACS –

In discussion with radiology, it would be possible for this to happen but there would be a
personal cost to the practice to pay for the license (in the vicinity of $1000 one-off cost)
and then methods established to provide ongoing support for the service (which
currently could not be provided by the existing IT staff in DPH radiology)
If practices are interested in getting PACS, Dr Ben Wilson, clinical leader of radiology will
initiate a study – so please tell me in the first instance so that the need can be gauged.

COMMUNITY LAB REPORTS TO BE AVAILABLE TO HOSPITAL CLINICIANS ON ISOFT –

This is changing so that SCL results will now be visible to hospital staff through iSoft

DEXA/ DVT SCAN REPORTS ON ISOFT

‘Soon’, DVT scan results from the University-based Vascular Lab will be available on
iSoft.
Reported Dexa scan results are already on iSoft, under “clinical documents”. There can
be up to 3 weeks delay between the actual scan, and the reporting.

Dr Anne Worsnop, GP Liaison, Email: anne.worsnop@southerndhb.govt.nz

DISCHARGE LETTERS FROM DUNEDIN HOSPITAL
As a result of discussions with GPs at recent meetings regarding the 6 –hour rule for ED,
there will be some changes made to the process of producing discharge letters.

WISH LIST CHANGES TO BE MADE

The draft discharge letter should be This is mostly done already
given to the patient, in hard copy, at
the time of the patient’s discharge.

Discharge letters should be available to The draft letter will be now be visible
the GP as soon as the patient has been on iSoft outside the hospital so that the
discharged GP can see it immediately on patient’s
discharge This is new

Within the next 24 -48 hours this draft Internal department audits are being
letter should be checked and corrected implemented to check that this occurs
by the registrar, at which stage it is
signed off, stored in iSoft as a final
copy and sent electronically to the GP.

The electronic copy will have the This will be new – however it will
author’s name on it so that a GP has take up a year to implement!
someone specific to call if there are
early post discharge problems

There will be a hard copy often sent to This needs to continue as some GPs
the GP may not use electronic facilities at their
surgeries

Discharge letters need to be written in I am talking with the clinical directors

plain English -acronyms are jargon and about this on 31/5/11
can cause confusion

SMOs need to reinforce to RMOs It is planned that Registrars and House

recommendations of timeliness,
medication changes and when to phone
GP about a pending discharge that will
possibly produce complications for the
GP – eg warfarin on a Friday afternoon.
Letters need to be written with a
primary care focus
Officers, at their orientation will have
input from GPs/ pharmacists about
content and timeliness of discharge
letters. Trainee interns need to receive
some advice about writing discharge
letters also – This is new

Instructions for the patient and GP re Hopefully, the initiative above will
follow-up need to be precise and influence this.
preferably written in the place that says
‘follow-up’

Attention must be given to medication As above.

lists on discharge with additions/
deletions and changes of medication
being clearly shown

I would be pleased to hear from anyone about discharge letters, particularly when the
process seems to be failing, or going exceptionally well.
On our part, it is important that when we are referring to the hospital we pay attention
to the letters we send and avoid sending the patient in with a print-out of the last
multiple consults; we need to be succinct about the patient’s current problem and what
we want to achieve by the referral.

Dr Anne Worsnop, GP Liaison, Email: anne.worsnop@southerndhb.govt.nz

CARDIAC ECHOS – DIRECT ACCESS TO GPs
Direct access for GPs was initiated in Feb 2010 and has been functioning very well
according to Carol Foote, Charge Nurse Manager of Cardiology.
The department has been able to accommodate all requests and they have all been very
explanatory.
At present there is one Echo Cardiology Physiologist on maternity leave (left in March) so
the echo lists have blown out a little. This is resulting in the department reviewing if a
referred patient has already had an ECHO in the last 6-12 months, and if so, asking the
GP if a repeat is still required. If the patient’s circumstances have changed, then a
repeat ECHO will be organised.
The echo reports are still being sent out manually - the computer staff are working on
being able to transfer the reports onto iSoft – there is no suggestion of when that might
be completed.
If it is decided, once seeing the result of the ECHO, that a patient is best to be seen in
Clinic promptly, the GP will be asked to write a referral letter (a community referral). The
GP will be alerted of this.

UROLOGY
This is a reminder that Urology is unable to see the following complaints, and your help
in finding alternative pathways of care is appreciated
Mercy Hospital has an outreach fund which will consider part-funding cases
(for surgery) on their merit.

& Hydrocoele

& Circumcision

& Frenuloplasty

& Epididymal cyst

& Peyronnies Disease

& Impotence/Sexual dysfunction

& Infertility

& Vasectomy - refer to Women’s health

CLINIC FOR TRIAL REMOVAL OF CATHETERS (TROC)

Nicola Solomon (Clinical Nurse Specialist - continence) has started a clinic at ISIS on a
Monday and Wednesday at 1130, for trial removal of catheters.
The clinic is to provide for patients who have been seen by ED/Urology registrar/GP for
urinary retention and have required a catheter to be inserted for a short period, rather
than those awaiting TURP's.
The aim is to avoid TROCs happening in the later part of the week so as to decrease the
risk of an ED admission if patients go back into retention
GPs can refer to the catheter trial clinic via Community Services Co-ordination Centre
(CSCC)
When a TROC is planned, the District Nurse removes the catheter at the patient’s home
at around 0900 and then the patient comes to ISIS clinic for a bladder scan and review
to ensure that they are voiding adequate volumes (they will be asked to measure their
urine over the next few hours) and have no other problems. If the patient needs their
catheter reinserted, Nicola and the district nurse will do this at the clinic
However, those who require catheter changes due to BPH or Ca prostate will still need to
have their catheters changed by their GP because of the increased risk of urethral
trauma.

Dr Anne Worsnop, GP Liaison, Email: anne.worsnop@southerndhb.govt.nz

PAIN CLINIC
The Pain Service is run from the Department of Anaesthesia on the 5th floor of Dunedin
Public Hospital, but holds clinics in two outpatients’ clinics on the ground floor.
Referrals are triaged by Jenny Sandom, Clinical Nurse Specialist and discussed at a
weekly team meeting with the full team.

Medical Staff Other Specialist Personnel

Dr David Jones – clinical leader Clinical Psychologist 1
Dr Mike Anderson Physiotherapists 2
Dr Thomas Moeser Occupational Therapist 1
Clinical Nurse Specialist 1

All Pain Service personnel are part-time and work in other departments or outside the
DHB

ACC PATIENTS:
These are not seen as a matter of course at the hospital pain clinic - only in exceptional
circumstances. The Pain Service is not funded or resourced to see ACC cases. ACC
patients should be first referred to their case manager who has a list of pain service
providers. The case manager should be asked to arrange a comprehensive multi-
disciplinary pain assessment (CPA). Examples of where CPAs are done are:
Mercy Pain Service– assessment and recommendation of treatment rather than
overseeing it
Burwood Pain management Centre - Christchurch – assessment and treatment

NB: Loss of weekly compensation from ACC does not mean loss of entitlement to
assessment or treatment for an open claim.
The provider help line 0800 222 070 can advise on the status and case manager details
of a client’s claim.

REFERRING TO THE DUNEDIN HOSPITAL PAIN SERVICE FAX 03 4747650

It is useful to accompany the referral proforma (available on GP part of southern DHB
website) with a letter which pays attention to specific questions. This will help with the
triaging of the patient and reduces delays in processing.

DESCRIPTION OF THE PAIN:

– pain - site of current problem
– is there more than one pain?
– cause if known
- is it cancer related?
- accident?
- is it post –operative pain ( eg post caesarean, mastectomy)?
– characteristics, does it seem to be neuropathic?
– duration – be specific, shorter duration since onset is considered more urgent.
– previous analgesic medications tried

What investigations have already been done? (Please include copies if you have them, as
private records are not always easily accessible)
Has the patient had previous pain assessments – if so where – copies?
Social status; specific issues you are worried about.
Work status – is there a threat of job loss?
Co-morbidities

BOOKING APPOINTMENTS:
The Pain Service uses a ‘Patient focused’ booking system for new patient assessments.
This is to reduce the missed appointments of patients who receive their appointment in
the mail. The rationale is that if they phone to make an appointment, they want one,
and if they indicate the day that suits them they are more likely to attend on that day.

Dr Anne Worsnop, GP Liaison, Email: anne.worsnop@southerndhb.govt.nz

FOLLOWING TRIAGING
x The patient will be sent a letter asking them to contact the Pain Service to make
an appointment
x If they do not reply within the specified time the referral is closed. The referrer is
notified.

THE ROLE OF THE PAIN CLINIC:

Patients have a first assessment that lasts 2 hours, is multidisciplinary and holistic.
They are assessed clinically/ psychosocially/ functionally with approximately 4 medical
and allied health staff in attendance.
From this a pain management plan is formulated which could include:
Medication adjustments
Functional rehabilitation which may include exercise and/or TENs trial
Psychological interventions such as cognitive behaviour therapy, sleep
therapy, etc
Pain management programme (group) for self management strategies –
(not available until September 2011)

Once a patient is discharged from the clinic it is possible to refer back to the Pain Service
if problems arise.

PAIN CLINIC WAITING TIMES

Urgent – 6 weeks
Semi-urgent -16 weeks
Routine – 24 weeks

BREAST SCREENING
Breast screening has a new consultant radiologist - Dr Shelley Boyd who is fully
accredited to BreastScreen Aotearoa. Shelley is undertaking Diagnostic and Screening
which is a relief to Prof Doyle who has been our soul consultant in Dunedin for a number
of years.

OPHTHALMOLOGY
Like all services, the eye department is experiencing an ongoing increase in demand for
services. Based on current referral patterns we are unable to meet all the demand for
an FSA (first specialist appointment). Based on governmental policy we may only accept
the number of patients we can see within 6 months, and this is based on volumes we
have been asked to provide. This means that we will only accept your patients where the
referral is urgent. This means all referrals triaged as semi-urgent and routine are being
returned to GP care.
Joanne Rowe | Unit Manager | Eyes

TIA PATHWAY
Dr Wendy Busby, who runs the urgent TIA outpatient clinic is asking that we try to use
the TIA Assessment guidelines and referral template which you will find in the GP section
of the Southern DHB website – under heading ‘department/ specific service’, and then
under General Medicine. If we use the template, then referrals to the clinic offer Wendy
the information she needs to prioritise, additionally it prompts us to review current
medications and preventative strategies for that particular patient.

WEBSITE
The format of this has been changed to hopefully make it more intuitive. Clinical
information will be under ‘department/specific service’, along with access criteria and
referral guidelines for each specialty.
For example, the Pain Clinic information above can be found under its own heading.

Dr Anne Worsnop, GP Liaison, Email: anne.worsnop@southerndhb.govt.nz

PUBLIC ORAL HEALTH – CHANGES TO PROVISION OF THESE SERVICES
The school based dental service is in the process of becoming the Community
Oral Health Service. This reorientation of the service will mean children will be seen on
appointment accompanied by their parents/caregiver. This will create the opportunity for
the dental therapist to promote good oral health practices to both the parent/caregiver
and the child. The Southern DHB is currently commissioning new fixed and mobile
clinics, replacing the old school dental clinics with new up to date facilities. These new
facilities will come online over the next 2 years.

As part of this change Angela Benn (Senior Public Health Dentist for the DHB) is asking
dental therapists to contact the relevant general practitioner for guidance, as to whether
a particular child might need antibacterial prophylaxis for planned dental procedures.

The dental therapists will send the letter below.

Dear Doctor,

Re Name
Address
Date of birth
NHI number

Medical condition of concern:

The parents/caregiver of ………… have informed me that he/she has

……………………………………………………………
The patient needs the following dental
treatment……………………………………………………………………………………

Please could you advise me whether antibacterial prophylaxis is necessary

when………………. has their treatment.

Thank you,
Kind regards,
……………..

If there are any suggested changes, please e-mail the suggestions to Angela at
angela.benn@souhterndhb.govt.nz

MEDICAL COUNCIL MEETING re OPTIONS FOR TRAINING DOCTORS

PrevocationalTrainingRequirementsfor
DoctorsinNZ 

The Council aims to enhance the training experience for junior doctors and ensure they
gain the core general competencies to practise across the breadth of medical practice in
both primary and secondary care settings.
Medical Council NZ invites all doctors (junior & senior) to attend the following discussion
session:
Barnett Lecture Theatre
Dunedin School of Medicine
University of Otago
(located on the 1st Floor, Ward Block, Dunedin Hospital)
Thursday 9 June 2011, 5:30pm.
Light refreshments will be provided.
The discussion paper and submission details can be found at www.mcnz.org.nz

Dr Anne Worsnop, GP Liaison, Email: anne.worsnop@southerndhb.govt.nz