Descriptions
The practice systematically manages referrals by:
A. Giving the consultant or specialist the clinical question, the required timing and the type of referral;
B. Giving the consultant or specialist pertinent demographic and clinical data, including rest results and the current care plan;
C. Tracking referrals until the consultant or specialist's report is available, flagging and following up on overdue reports.
It is important that the practice track patient referrals and communicate patient information to specialists. Tracking and following up on referrals is a way to support patients who obtain services outside the practice. Poor referral communication and lack of follow-up (e.g., to see if a patient kept an appointment with a specialist, to learn about recommendations or test results) can lead to uncoordinated and fragmented care, which is unsafe for the patient and can cause duplication of care and services, as well as frustration for providers.
Referrals tracked by the practice using a log or electronic system are determined by the clinician to be important to a patient's treatment, or as indicated by practice guidelines (e.g., referral to a surgeon for examination of a potentially malignant tumor; referral to a mental health specialist, for a patient with depression; referral to a pediatric oncologist, for an infant with a ventricular septal defect).
a. The referring clinician provides a reason for the referral, which may be stated as the clinical question to be answered by the specialist. The referring clinician indicates the type of referral, which may be a consultation or single visit; a request for shared- or co-management of the patient for an indefinite or a limited time, such as for treatment of a specific condition; or a request for temporary or long-term principal care (a transfer). The referring clinician clarifies the urgency of the referral and specifies the reasons for an urgent visit.
b. Referrals include relevant clinical information, such as:
- Current medications.
- Diagnoses including mental health, allergies, medical and family history, substance abuse and behaviors affecting health.
- Clinical findings and current treatment.
- Follow-up communication or information.
Including the referring primary care clinician's care and treatment plan in the referral, in addition to test results/procedures, can reduce conflicts and duplication of services, tests or treatment. If the practice sends the primary care plan with the referral, the specialist can develop a corresponding specialty plan of care. Ideally, the primary care plan, developed in collaboration with the patient/family/caregiver, is coordinated with the specialty plan of care, created in collaboration with the patient/family/caregiver and primary care.
c. A tracking process includes the date when a referral was initiated and the timing indicated for receiving the report. If the specialist does not send a report, the practice contacts the specialist's office and documents its effort to retrieve the report in a log or an electronic system.