This article clovers:
Patient behaviour
What do we mean by patient behaviour?
Patient behaviour plays an important role in the success of treatment for the patient. By understanding patient behaviour, healthcare professionals both in non clinical and clinical settings can better support the patient and their needs.
Why is patient education important?
In the event your patient submits an eConsult using the incorrect clinical template or submits a clinical concern via the admin template, they are unfortunately skipping those important clinical and safety questions that relate to their concern/condition.
For example, should a patient have a head injury related issue, they would be best suited to complete the head injury template. If the patient however submits a head injury concern on the admin template or a template not applicable to their injury, the questions asked throughout the online consultation will not ask those important relevant questions, and may potentially pose a serious risk to the patients health and safety.
Patients Misusing the eConsult Platform
It is essential that when submitting an eConsult, your patients are doing so by using the correct template or the most appropriate template based on their needs or concerns.
Examples of a patient misusing eConsult includes:
Submitting a Clinical Concern via the Admin Template
What is the issue?
eConsult clinical templates are designed to gather a lot of patient information and symptoms to enable efficient and safe management within the practice. For this reason the clinical templates are substantially longer than the administrative template. This can entice people to submit an administrative template, incorrectly, to have a reduced number of questions and save time.
However the admin template does not ask those important safety questions that a clinical template would, therefore, would not appropriately flag the consultation in the Smart Inbox and no emergency or urgent re-directs would trigger. This could pose a risk to the patient as the admin response time is longer than the clinical response time, so the consultation could be left without action for longer.
Without the structured data gathering less relevant information is obtained and patients are unable to upload photographs. This reduces the richness of the data which directly impacts the effectiveness of the eConsult.
How does it impact practices/patients?
Incorrect usage of the template impacts the practice, but the patient also. This can include:
The patient may be put at risk if they are not responded to fast enough.
It does not ask important safety questions, so in the event that the administration team may opt to just forward this onto the GP or nurse to deal with, it will not ask the patient questions that would be of high importance to a clinician.
It does not offer emergency or urgent re-directs, therefore, if a patient's condition is of concern, the platform will be unable to flag this through the admin template.
The patient will not receive the adequate help and support needed to treat or control their condition.
It wastes admin resources as the administrator will need to reach out to the patient and ask that they re-submit the eConsult under the correct template.
It does not allow the patient to upload photos which in turn, helps the clinicians reviewing the eConsult to see clearly the concern.
The patient will not experience the benefits of the platform and as such, will want to call the surgery instead - which will impact the surgery phone lines.
Submitting an Admin Request via the Clinical Template
What is the issue?
Clinical templates should exclusively be used for clinical concerns and issues, misuse of the clinical templates can cause patients using valuable clinical resources for menial requests. Should the clinician reject the eConsult submission, patients will have to re-submit their eConsult, thus giving them a bad experience of the platform.
How does it impact practices/patients?
Incorrect usage of the template impacts the practice, but the patient also. This can include:
The patient will not receive the adequate help requested right away and may cause extra and unnecessary contacts within the practice.
It wastes clinical resources as the clinician will have to contact the patient to inform them that their eConsult is for an admin request and is not deemed clinical. This amount of time could have been better put to use for a patient requiring actual clinical help.
Time is required to redirect and close the eConsult that has been submitted inappropriately. This subsequently will cause delays to get back to other patients that have submitted appropriate requests..
The patient will not experience the benefits of the platform and may choose to call the surgery instead, for future contacts, which will impact the surgery phone lines.
If capping is enabled at a practice, this will impact the number of eConsults that are able to be submitted, resulting in patients who need help being unable to submit their clinical enquiries.
Submitting a Clinical Concern on the Incorrect Clinical Template
What is the issue?
There are several clinical templates for patients to choose from when they are submitting an eConsult into the practice. Submission of an incorrect clinical template for the patient’s condition or concern could be accidental (unsure which is the relevant template) or purposeful (perhaps to avoid urgent redirects). However, whatever the reason maybe, the use of the incorrect clinical template can have significant implications.
The clinical templates are built to ask questions that are pertinent to the condition, based on patient answers the following questions are generated. Therefore, if the template used does not ask the patient the important questions relevant to their condition. If the template questions are not relevant to the issue, it may not ask the questions that would trigger an emergency or urgent re-directs.
How does it impact practices/patients?
Incorrect usage of the template impacts the practice, but the patient also. This can include:
Using the incorrect template wastes clinical resources as the clinician will need to reach out to the patient to complete a full consultation (the data gathered will likely be irrelevant for decision making during the consultation.) alternatively, the clinician may ask the patient to re-submit the eConsult under the correct template.
The template won’t ask the specific questions for their condition, therefore could pose a potential risk to the patient.
The template used may not allow the patient to upload photos which in turn, helps the clinicians reviewing the eConsult to see clearly the concern
The patient will not experience the benefits of the platform and may choose to call the surgery instead, for future contacts, which will impact the surgery phone lines.
The clinician will also have a poor experience and may feel the platform does not offer significant timesaving.
Patients Not Fully Completing a Template
What is the issue?
Partially complete template can impact the effectiveness of the eConsult. Providing brief information around their issue or condition, that does not give a clear indication as to what the exact issue is, and what the patient has tried to treat it.
For example submitting:
Q1. Please explain your issue/concern in detail | A1. Pain in leg |
Q2. Have you tried anything for this? | A2. Yes |
Versus:
Q1. Please explain your issue/concern in detail | A1. I have pain in my left leg, just above my knee from a fall I had last week. There is quite a lot of bruising in the area and some slight swelling. I cannot apply any weight on the area. |
Q2. Have you tried anything for this? | A2. I have tried hot and cold compresses, however neither are working. I also take paracetamol 3 times a day for the pain. |
Additionally, patients inputting “N/A” or adding a full stop inside of the free text boxes to allow for skipping forward and missing questions. Although this will operationally allow the eConsult template to progress forward, it will reduce the usefulness of the information.
Omitting the uploading of relevant photographs. For example, a patient with a rash. It would be beneficial in this instance for the clinician reviewing the eConsult to see photographs of the rash to have a better understanding in the treatment plan.
Another significant issue that could arise with this behaviour, is not highlighting any factors that may be a direct contribution to the original issue. For example, a patient may indicate a headache and the general feeling of being unwell, however not highlight that they have developed a skin rash, which would help the clinician reviewing to factor in the possibility of the patient having shingles.
How does it impact practices/patients?
Partial completion of the template impacts the practice, but the patient also. This can include:
Submitting a template with sparse information wastes clinical resources as the clinician will need to reach out to the patient to complete a full consultation, alternatively that they may ask the patient to re-submit the eConsult under the correct template.
The patient may not receive the adequate help and support needed to control their condition/help them and may potentially be mis-diagnosed. If the patient is mis-diagnosed based on the information they have provided, they could put themselves at potential risk.
The patient will not experience the benefits of the platform and may choose to call the surgery instead, for future contacts, which will impact the surgery phone lines.
Submitting Multiple Concerns Through One Template
What is the issue?
Misuse of the template, by sending multiple concerns via one template, can occur either intentionally or unintentionally. This can happen on both admin and clinical templates, and can also come in the form of a blend of the two.
A single template refers to 1 template per 1 condition. A patient who misuses the template by submitting multiple concerns will bypass the recommendations of 1 template per 1 condition, and instead input several issues into the 1 template through the free text box features.
For example, a patient submits an Admin request, however upon receipt the administration team identify the admin request also has a clinical concern included, This will either require the admin staff taking additional steps to pass the clinical request onto a clinician to review, or the admin staff will be required to go back to the patient and ask that they re-submit the templates individually - both of which will add to the administration teams time. This is also applicable from a clinical perspective.
How does it impact practices/patients?
Misuse of the template, by submitting multiple conditions through a single template impacts the practice, but the patient also. This can include:
The template won’t ask the specific questions for (one or both of) their condition(s), therefore could pose a potential risk to the patient.
Wastes the resources, as the clinician or administrative team will need to reach out to the patient to ask that they re-submit the eConsult under the correct template/s. This is not only inconvenient for the patient, but for the admin staff also.
The patient may be put at risk if they are not responded to fast enough.
The patient will not experience the benefits of the platform and may choose to call the surgery instead, for future contacts, which will impact the surgery phone lines.
Misusing the ‘Go Back’ feature when not appropriate (i.e platform redirects them).
What is the issue?
The ‘Go Back’ feature is found from page 2 onwards of every eConsult template, and is there to serve patients who may have accidentally chosen the incorrect answer. Although the ‘Go Back’ feature is often a helpful option that is used legitimately, there is also a risk that feature is misused to reduce the severity, so the eConsult template can continue.
The emergency/ urgent redirect is a safety feature that triggers when a patient answers a series of questions that would require emergent care. The patient may disagree with the emergency redirection and decide to go back a stage and answer the question differently. By doing this the patient risks not receiving the adequate help and support needed to treat or control their condition.
How does it impact practices/patients?
Misuse of the template, by ignoring urgent redirects impacts the practice, but the patient also. This can include:
If the patient goes back and changes their answer, despite receive an emergency re-direct, they will be putting themselves in serious risk to their health.
The surgery staff/ clinicians may be unable to pick up on how serious the patients' issues are. For example, a patient may be having symptoms of a serious condition requiring urgent hospital admission. If the patient goes back, and amends their answer to move past the redirect, the information is not accurately relayed through the platform. If the patient then writes in the free text box the symptoms the clinician may only become aware of their urgency of the eConsult when they are able to review. With only free text information the system will not pick up the seriousness of the symptoms and therefore provide no flags.
The patient will not experience the benefits of the platform if they abuse or misuse it, and will be unable to understand and appreciate it fully when it re-directs them to other support options best suited to their needs.
Patients misusing the platform, the surgery may feel the platform is not working well for them, and may choose to switch the platform off entirely.
Possible Solutions/Advice?
Educating patients on the benefits and the reasons for the different templates and the impact this has on patient safety will be vital for effective use of the eConsult.
Practice Website
In addition to the eConsult banner present on the Practice website, it may be beneficial to create an additional page, on the website, dedicated to advising patients how they can correctly and safely submit an eConsult.
For example a “Do’s and Don’ts” of using the eConsult platform.
Do | Don’t |
Do use the appropriate template that is aligned with your symptoms or conditions. (If you can’t find the most appropriate use the “Request other advice”) | Don’t submit multiple issues or concerns in one eConsult template. |
Do wait until the time specified on the eConsult prior to contacting the practice. (If your symptoms are worsening call 111). | Don’t use the administrative template for clinical concerns. |
Do attach relevant photographs to describe your condition if appropriate. (e.g. a rash) | Don’t input non descript answers, or answers that do not elaborate on the condition or the concern that you have. (e.g. N/A) |
On the practice website it is important to highlight why eConsults need to be submitted on the templates that match the patients needs, the dangers of incorrectly submitting eConsults and how it can affect both the patient and staff at the surgery. Such as listing scenarios:
Scenario 1 - Patient submits a clinical concern via an administrative template.
The patient submitting an inappropriate template means the patient will not receive the correct targeted questions that obtain all the relevant details and will not redirect the patient if their condition requires more urgent input (A&E/999).
Additionally, without having the correct template means that when the eConsult arrives in the Practice’s inbox it does not flag as a clinical request (meaning this will be responded to within X days compared to a clinical consult being responded to within X days). Therefore this could delay the patient getting treatment.
Additionally, the practice will waste resources by having to contact the patient to resubmit their request.
Scenario 2 - Patient submitting a partially complete template.
The patient has submitted a clinical template for back pain including answers on “N/A” in all of the free text boxes. When the template is received the clinician is unsure where exactly the pain is coming from on the patient's back, how long this has gone on for, the cause and what methods the patient has tried to treat this.
The clinician feels they cannot adequately help the patient with the information provided, therefore, the clinician is unable to make effective use of the information gathered on the template. This will result in the practice wasting resources to contact the patient to resubmit their eConsult. This will be frustrating for the patient to repeat this.
Additionally, linking short videos explaining how to use the platform and the appropriate ways to use it, may provide engaging information whilst also highlighting safety concerns.
Patient Communications and Social Media
Send out communications via text/email patients advertising eConsult to patients, including a link to our articles on how to submit an eConsult safely including the importance of submitting clinical based concerns/requests on the clinical templates and not the admin templates.
Additionally, communicating to patients via newsletter is also an opportunity to highlight the services that eConsult provides and the way the patient can get the most out of the service, by using the platform and templates correctly.
If the surgery uses social media, posting how to guides and videos may be beneficial to engage with patients on how to use the platform and the risks of using the incorrect template. Patients may end up engaging better if the information is provided to them via video format, and many patients use social media to keep up to date with their surgery’s noticeboards.
Another proactive communication channel could be, videos can also be played on the reception screen for patients whilst they wait for an appointment, and leaflets and posters should be readily available for patients to take away and read.
Patient Education Sessions
It may be beneficial to hold eConsult training days for the patients to join either remotely or in person to learn how to complete an eConsult correctly and what to avoid. This may be an opportunity to get your PPG involved!
Robust Policies
Implement robust policies for wrongly submitted eConsults. When a staff member or clinician identifies an eConsult has come through with multiple submissions attached or an incorrect template, it is strongly encouraged that the patient is informed that their eConsult will be rejected due to misuse. At this stage the dangers of doing this can be highlighted to the patient and the patients should be educated on how this could affect both the surgery and the patient directly. This could then be an opportunity to send some help articles/videos to educate on how to correctly use the platform and why it is important to submit on the correct template.
Document a note onto the patient file that they have been rejected for incorrectly submitting an eConsult. This will provide staff with awareness if this becomes a repeat offence.
Another mitigation that could be put in place for patients submitting admin templates for a clinical concern, is implementing an incentive of the response times. For example: admin = 3 days, clinical = 1 day, therefore; patients who need clinical support are better off using clinical templates.
If you have any questions or you feel that this article could be improved, please feel free to give us some feedback by emailing us, pressing the emojis below or using the chat button on the bottom right-hand side of this page to speak to one of the eConsult team.