From: Goff, James

Sent: Friday, November 20, 2015 9:24 AM

To: Pierce, Aaron M.; Wagner, Lana K.; Lin, Henry; Mao, Jenny T.
Cc: Hnatiuk, Oleh; Neis, Patricia C.; Esquibel, Edwin A.
Subject: RE: Cancelled Consults
I would recommend that your section meet with Henry to understand the
process.
We have a major issue with open consults greater than and we are going
through a facility wide herculean effort to resolve many old consults.
To be clear, the Integrated Care staff are not the bad guys here.
Do not shoot the messenger- get smart about the process
JMG
From: Pierce, Aaron M.
Sent: Friday, November 20, 2015 9:13 AM
To: Wagner, Lana K.; Goff, James; Lin, Henry; Mao, Jenny T.
Cc: Hnatiuk, Oleh; Neis, Patricia C.; Esquibel, Edwin A.
Subject: RE: Cancelled Consults
-I have had similar problems over the past week with multiple cancelled
outside referral consults. I have had multiple overnight oximetry studies
and PSG orders cancelled. Most of the orders are approaching 1 year old. Is
there something particularly important/relevant about a consult still being
open after a year?
-Regardless, I am getting frustrated at having to respond to these
inappropriately completed consult notifications and asking that they
(integrated care) reopen the consults. I have also been asked to replace the
consult if it is still indicated, however I think that doing that is
unacceptable for two reasons.
1) If it is really taking a year for Integrated Care/Triwest to complete
orders, that should be documented accurately in the EMR.
2) I do not have the time to reorder consults and review my
notes to appropriately justify the request. I do not need to repeat work.
-I would greatly appreciate help in resolving this issue.
ap
Aaron Pierce, M.D.
Sleep Medicine Services
New Mexico VA Medical Center
From: Wagner, Lana K.
Sent: Friday, November 20, 2015 8:56 AM
To: Goff, James; Lin, Henry; Mao, Jenny T.
Cc: Hnatiuk, Oleh; Neis, Patricia C.; Esquibel, Edwin A.; Pierce, Aaron M.
Subject: Cancelled Consults
All,
Can anyone shed light on what is happening with our consults? They are being
inappropriately cancelled. Here are some examples of the types of things
that I am talking about:

(1)
Pt sent out for an oral appliance; consult was cancelled based on the
fact that sleep study (performed HERE) is in VISTA (the pt was sent out BASED
on that study).
(2)
Overnight oximetry ordered >1 year ago; cancelled because it hadnt
been performed/was expired/results were in (they werent). There are LOTS of
these.
(3)
Pt sent out for study (no results); consult closed because a PCP note
says that Sleep Med had ordered the test.
It is distressing to find out that many of the studies that we ordered have
not been performed. It is horrifying to think that these patients are going
to fall through the cracks because these consults are being cancelled.
Surely we are not cancelling these >1yr old consults in order to make is seem
that care is not being delayed. It seems that our time as an institution
would be better spent trying to get the consults completed than trying to
find reasons to cancel them.
Can someone please help?
Lana
Lana K. Wagner, M.D.
Medical Director, Sleep Medicine Services
New Mexico VA Medical Center
Associate Professor, Internal Medicine
Division of Pulmonary, Critical Care, & Sleep Medicine
University of New Mexico School of Medicine