In British hospital practice the traditional ‘firm’ secretary has increasingly been replaced by a panoply of personnel, often responsible for supporting multiple clinicians and co-workers; typists, schedulers, support managers, workload co-ordinators and personal assistants all contribute to clinical pathways. Some units outsource some of these functions elsewhere within or outside the organisation, even overseas. The opportunity for miscommunication and administrative chaos is therefore great. A structured letter with the acronym ‘CARE’ is recommended to combat this risk and improve administrative efficiency.
CARE stands for copies, arrangements, results awaited, enclosures and is conveniently printed at the bottom of each letter
Copies
Patients should receive copies of every letter about them unless they would cause harm or distress,1 although it may then be appropriate to send them a copy of a letter with an ‘addendum on all copies except the patient’s’. This practice provides the patient with an aide memoire of their consultation. It also allows clinicians to write a single letter to multiple recipients, ensuring global appreciation of the clinical details. A structured letter makes it easier to navigate to relevant sections; a practice that will become common to all as standard communication headings are introduced across the UK health service.2
Arrangements
Investigations, operations, admissions and clinic appointments can be listed providing a single locus for schedulers to check. Where there are special arrangements appropriate details can be included.
Results awaited
Any investigations with outstanding results can be listed, preferably with an indication of when the result is likely to be available. A copy of the letter can be retained to ensure that the investigation result is sought if it fails to arrive timeously; a weekly ‘results trawl’ is recommended.
Enclosures
Investigation requests can accompany copies of the letter to departments providing diagnostic services facilitating more informed reporting. Information sheets can be sent to patients and GPs to educate them; this is a useful and efficient adjunct to informed consent.
‘CARE’ costs nothing, is simple and universally applicable. It is commended to support good medical care and as a risk-reduction strategy.
References
- 1 .The NHS Plan: a plan for investment, a plan for reform. London: Stationary Office, 2000. Available online at http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_118522.pdf [Accessed 9 January 2015]. [Google Scholar]
- 2 .Health and Social Care Information Centre, Academy of Medical Royal Colleges Standards for the clinical structure and content of patient records. London: HSCIC, 2013. [Google Scholar]