Improving timely communication and access to referral care remains a challenge to physicians and patients alike. Physician referrals to specialists have doubled over the past decade according to Medical Economics (2014). Theoretically, that reduces the risk for referring physicians, but the referring physician becomes responsible for coordinating the care. It becomes their responsibility to track and review the consultant’s results and assure appropriate implementation of the care plan.

The importance of improving communication between referring and consulting physicians is imperative, but it is only effective if patients have timely access to the specialist. The lack of effective referral communication can lead to:

– Delays in diagnosis

– Failure to act on abnormal test results

– Delays in treatment

– Failure to prescribe

– Failure to follow-up with further testing

This can lead to patient safety and health issues, a decrease in patient satisfaction and compliance, as well as an increase in liability risk.

The introduction of electronic medical records (EMR) was intended to improve legibility and provide easier access to patient’s records. Unfortunately, communication is not improved if the question posed by the referral is not answered. EMR information can lead to voluminous notes, that will be confusing at best or not even read. To reduce confusion and assure appropriate completion of the referral and follow-up, the following steps need to be addressed.

1) Determine exactly what the consultation request is for and document in the medical record

– Advice

– Opinion

– Recommendation for subsequent care

(a) Be specific about what you need to know

2) Will there be a transfer of care (hand-off)?

– Document who is responsible for their part in care issues and inform the patient

3) Send pertinent info to the specialist that pertains to the consult

4) Inform patients of their responsibility in following the treatment plan

– Educate patient of the importance of the referral and document the discussion in the medical record

5) Indicate a reasonable amount of time that the referral results should be received

– Ask the Specialist to contact referral office if the patient is a no-show

– If the patient is no-show, determine why and document the reason in their record

6) Develop a referral tracking mechanism

– Schedule a return appointment to review consult results before the patient leaves the office

– Upon completion of consult, ensure the records were:

(a) Reviewed

(b) Signed and dated

(c) Placed in the patient’s medical record

– Non-compliance by the patient requires:

(a) Documentation of follow-up attempts

(b) Documentation of communication with the patient reinforcing the importance of getting the test completed

(c) Document action of non-compliance

– Non-compliance by consult

(a) Contact consultant if a report is not returned

– Document why the consultants recommendations are not being followed

(a) Obtain a second opinion from another consultant if necessary

1) Send a written report in a timely manner

– Include:

(b) Recommendations

(c) Interventions suggested or done

2) Delineate responsibility for ongoing care

– Who will follow-up on further testing

– Keep the primary care physician informed of ongoing care

3) If there is an emergent situation or clarification of consult is needed, contact the referring physician and document the conversation in the record

4) If the patient is a no-show:

– Contact the referring physician

– Document the no-show and contact the referring physician

1) Document the role of each physician in the record

2) Develop scheduling guidelines

– Tracking

– Timeliness of consult

– Ability to accommodate urgent requests

3) No-show policy steps documented in record

– Contact with referring physician

– Contact with patients

4) Establish clear rules for all physicians and clearly sign-off when responsibility is completed