The QCC is an independent group of providers who utilize their experience to evaluate cases that are brought forward by Maple patients, providers or staff in which shortcomings in care or other provider issues have been identified. Examples include but are not limited to alleged or perceived poor patient customer service, poor patient outcomes, inappropriate communication or failure to consider MAC clinical guidelines.
Since its inception, the QCC has continued to meet monthly to review cases initiated by patients or providers. Below are some key learnings and themes from QCC cases.
Complete assessments with clear communication for patients
Complete assessments with clear communication for patients
It is important to ensure a complete health assessment and include documentation for all visits, including simple requests for prescription refills and sick notes. a complete assessment, even if this has been documented in previous visits. A frequent concern in QCC cases is insufficient provider assessments.
While it's ultimately the responsibility of each individual provider to determine the appropriate approach to assessing the patient, here are a few helpful tips learned from QCC cases:
Conduct a focused health assessment (past medical history, allergies, etc) relevant to the individual’s presentation.
Avoid listing several questions at once at the beginning of a consultation, as patients may feel they do not have the opportunity to respond appropriately.
Don’t ask questions in rapid succession without allowing the patient time to respond. Number individual questions if you ask more than one at a time to make it easier for the patient to follow and answer.
Move to video if you are unable to communicate effectively by text.
Don’t use medical jargon, which may be confusing for the patient.
Return to clinic guidelines
Return to clinic guidelines
It is the provider's responsibility to give appropriate patient education on the diagnosis and treatment - this includes explaining your recommendation to the patient, what to expect, and when to seek reassessment in person or via telemedicine. It is important to ensure that the patient is provided with the opportunity to ask any additional questions at the end of the consultation to ensure an understanding of both the treatment plan and return to clinic guidelines. This ensures all concerns are addressed and complete before ending the consultation.
The information should be tailored to each patient and each clinical situation. This advice should include instructions regarding the medication, potential side effects and possible symptoms or signs alerting to danger, the urgency of seeking additional care, and where to find that care.
The discussion with the patient should be documented in the medical record.
“Webside” Manner
“Webside” Manner
When seeing patients on Maple, providers should ensure they have adequate time to give their undivided attention to the patient and the issue at hand. We understand that in some rare instances, emergencies may arise, and you’re unable to complete the consultation. If this happens, we suggest ending the consultation without charge and asking patients to resubmit their consultation request to speak to another provider.
Tips:
It is important to note that using text written entirely in capitals, ellipses (“....”) or exclamation marks (“!”) in written communication during a consultation is inappropriate as it can be perceived as dismissive and unprofessional.
Please keep in mind that your written communication in the consultation is part of the medical encounter, and informal writing like this could make the patient feel that the experience was not reputable or professional.
Documenting the patient interaction
Documenting the patient interaction
Providing virtual medicine requires you to create and maintain patient records similarly to in-person care and adhere to the Standard of Practice of your individual regulatory college. Every provider is responsible for documenting the care and recommendations they have provided. Many QCC cases were flagged for incomplete or poor documentation.
Documentation serves as communication with other providers, demonstrates accountability to the patient and may be used in legal investigations and other legal proceedings. It can be optimized by:
Using a standard format (e.g. SOAP)
Using only standard abbreviations are used (or none at all)
Making notes that are objective and relevant
Tips:
Audio and video consultations require documentation, as voice calls and video files are not saved in the consultation record.
If a consult was done either fully or partially by video or phone, you should always ensure you write a summary of the visit either in the text (where a patient can read it over and agree with what you wrote) or in the private note section located in the patient’s chart (which won’t be available to the patient but will be available to other providers on Maple).
A good note should allow a subsequent provider to understand your diagnostic reasoning, justification for excluding other diagnoses, and reasons for proceeding as you did.
Clinical notes do not need to be exhaustive but should give an adequate picture of the clinical situation.
Appropriate information may include the health condition to be treated, history of the condition, symptoms, treatment history including drug therapy and outcomes, and allergies or intolerances to drugs.
Respiratory assessment
Respiratory assessment
These cases are often accepted despite being inappropriate, with symptoms of shortness of breath indicated in their reason for the request. If the option is available, a custom rejection to inform the patient their case requires an in-person assessment would be the most appropriate choice in these cases.
If rejections are unavailable, providers should conduct a video consultation to assess for respiratory distress and provide guidance on the next steps, including seeking care at ER if needed, pending your assessment. Video allows you to assess the severity of the patient’s symptoms and determine the best care setting. If there are signs of respiratory distress, send the patient immediately to the emergency department.