Recall vs reminders

Author: Rebekah Cox, APNA

One of the common questions asked of APNA’s Nurse Support Line is around the best practice management of recalls and reminders. There’s no one-size-fits-all answer, but there are a few key points that practitioners and workplaces should consider in establishing or reviewing recall and reminder protocols. 

Nurses play a key role in implementing effective preventative health services in primary health care¹, and often lead the team in the management of recalls and reminders. A systematic approach to how preventative care is implemented in individual workplaces is essential, as we know higher levels of preventive services are likely to reduce morbidity and mortality from preventable diseases.²

So, where to start? To quote Maria from The Sound of Music, the beginning is a very good place to start. When establishing or reviewing your recall and reminder system, it is imperative that everyone (including administration staff) is aware of and understands at a minimum, the difference between recalls and reminders, and for nurses and practitioners, what constitutes clinical significance. 

In the establishment or review of the recalls and reminder system, ensure your workplace is following the relevant recommended guidelines or accreditation standards around the management of recall and reminder systems, such as:

• Aged care – Quality of Care Principles⁵
• Correctional health – National Commission on Correctional Health Care Standards⁶
• General practice – Standards for general practices (4th edition) including Interpretive guide for Aboriginal and Torres Strait Islander health services⁷

Ensuring that risk is mitigated while managing the daily requirements of the workplace and workload are taken into consideration can be a fine balancing act. If each member of the team is aware of differences between a recall and a reminder, this can certainly help in reducing the workload of everyone involved. Ensuring practical elements of the process are considered is crucial to the recall and reminder process.

Key terms

Reminders

Reminders are used to initiate prevention with patients who may benefit from participating in appropriate health promotion and preventive care activities or who may require appropriate and timely review of their treatment and/ or their medical devices. Reminders can be either opportunistic or proactive.^3,4

Recalls

Recalls are a proactive follow up to a preventive or clinical activity and are designed to facilitate patients receiving further medical advice in relation to matters of clinical significance.^3,4

Clinical significance

This depends on the probability that the patient will be harmed if further medical advice is not obtained as well as the likely seriousness of the harm. While not every test or referral needs to be confirmed, if there is a reasonable suspicion of a  clinically significant outcome, then the doctor has a duty to attempt to follow up and recall the patient. Inadequate follow-up and recall may jeopardise the patient’s healthcare and place the responsible doctor(s) at medico-legal risk.³

A few key points below may be helpful to consider and ensure there is a consistent workplace-wide approach: 

• How will the practitioners communicate what is urgent vs non-urgent in their clinical notes?

Where will this be documented? Sometimes if it’s only documented in the results, this may not be accessible to administration staff. Ensure important notes are accessible to everyone where possible. If confidential, ensure to make notes general, i.e. need to see patient regarding recent results. 

• Who and how will patients be contacted for non-urgent recalls?

Sometimes this may be done by non-clinical staff but other workplaces may prefer only nurses contact patients for non-urgent recalls. 

• Who and how will patients be contacted for reminders? 

A text message, letter or phone call are all effective. Don’t forget to take patient preference or circumstances into consideration, i.e. vision or hearing impaired.

• How many times will patients be contacted?

I.e. if unsuccessful after three attempts, what next? 

• What happens if patients don’t attend their appointments? 

Is there a system in the appointment book to alert administration staff that the appointment is a recall or reminder and should be re-booked? 

• Ensure privacy is maintained in accordance with local state and territory laws, especially in regard to minors (<18). 

What is the workplace policy and procedure about giving results to minors? I.e. if a minor attended an appointment without a parent or guardian present, who should receive this result? 

• What will happen with the current recalls and reminders? 

Part of this process may include clearing the inevitable backlog of recalls and reminders. Although this can be a time consuming process, it can also be a great data cleansing activity. In the process of establishing or reviewing recall and reminder systems, APNA recommends that practitioners contact their medico-legal insurer for advice or precedent to inform their protocols. This may help the workplace and practitioners feel more assured about the implementation of recall and reminder protocols.

The importance of having effective, systematic protocols and procedures around recalls and reminders cannot be underestimated. This is especially true in light of the increasing burden of chronic disease and the ever-increasing workload of nurses and medical staff in primary health care. Making time for recall to reduce the risk of harm, and being proactive about reminders for preventative health, may be a small short-term sacrifice for a long-term healthier future to increase the overall health and wellbeing of your population. 

Key points for general practice

1. The practice needs a documented system for the follow up of tests and results, with a strong focus on risk management^3,7
2. The system should delineate mechanisms for dealing with normal results, abnormal results (urgent and non-urgent), and important tests/referrals^3,7
3. The system should delineate mechanisms for the follow up of results and the follow up of clinically significant tests^3,7
4. The system should cover how tests and results are communicated to patients^3,7
5. Effectively uses registers and reminder systems to prompt intervention and promotes best practice care.

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   APNA’s Nurse Support Line is a member benefit available exclusively to APNA members, and is available during work hours Monday to Friday on 1300 303 184.

References
1. Australian Primary Health Care Nurses Association: Healthy Practices Resource: Nursing Roles in General Practice, 2015, http://healthypractices.apna.asn.au/wp-content/uploads/2015/03/Nursing-roles-in-general-practice.pdf
2. Agency for Health Care Research and Quality, 2016, Reminder Systems for Immunizations and Preventive Services, https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/6-strategies-for-improving/health-promotion-education/strategy6r-reminder-systems.html
3. Australian Medical Association Position statement Patient Follow-Up, Recall and Reminder Systems 2013: https://ama.com.au/position-statement/patient-follow-recall-and-reminder-systems-2013
4. Royal Australian College of General Practitioners, Putting Prevention into Practice (Green Book): guidelines for the implementation of prevention in the general practice setting (2nd Edition), Reminders, Recalls and Prompts, 2006, https://www.racgp.org.au/your-practice/guidelines/greenbook/applying-the-framework-strategies,-activities-and-resources/ability/reminders,-recalls-and-prompts-(flags)
5. Australian Aged Care Quality Agency. Quality of Care Principles 2014. www.aacqa.gov.au/providers/accreditation-standards
6. National Commission on Correctional Health Care Standards www.ncchc.org/standards
7. Royal Australian College of General Practitioners Standards for general practices (4th edition) including Interpretive guide for Aboriginal and Torres Strait Islander health services, 2013, https://www.racgp.org.au/your-practice/standards/standards4thedition/practice-services/1-5/system-for-follow-up-of-tests-and-results
8. Australian Nursing and Midwifery Federation. Enrolled Nurse Self Assessment/Appraisal Tool and Professional Development Plan Booklet: National Toolkit for Nurses in General Practice http://www.anmf.org.au/documents/ANMF_National_Toolkit_for_Nurses_in_General_Practice_EN_Booklet.pdf

Source: Primary Times Spring: Volume 17 Issue 3, 2017