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Insight: Best Practices in Referral Communication

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Insight: Best Practices in Referral Communication

By Jennie Wright, RN, CRICO

Related to: Ambulatory, Communication, Documentation, Primary Care, Other Specialties

Processes to promote ongoing communication between referring physicians and specialists are essential to providing high quality and safe patient care. To date, maintenance efforts have tended to be provider-specific rather than process based. During discussions with physicians whose practice is undergoing a CRICO/RMF Office Practice Evaluation, the following methods were identified as helpful:

  • PCPs: Develop a collegial relationship with key specialists. This includes providing the specialist with appropriate and accessible contact information, making it easy for them to contact you when they have an important finding to relay. In addition, the reason for the referral, pertinent clinical information, and threshold of concern should be communicated in advance of the patient visit.

  • Specialists: Maintain a strong working relationship with referring providers (PCPs). Timely update of consult findings and treatment recommendations facilitates a strong collaborative relationship between referring providers and specialists. Confirmation of a significant diagnosis, a change or update based on further testing, and provision of treatment plans with recommendations for follow-up will empower referring providers to effectively manage complex patients.

  • All Providers: A shared electronic medical record can be used as a vehicle for ensuring that both parties are aware of a change in condition. Providers must alert one another if a review of a note is warranted.

  • E-mail has become the norm for communication between providers. Although a valuable tool, keep in mind that patient-specific details of clinical presentation, diagnosis, and treatment are confidential in nature. Providers should check with their sponsoring organization to ensure a secure network and communication policy are in place. Use of commercial accounts is discouraged for patient-related topics.

  • Documented communication is vital to optimal care and patient safety. Communication between providers regarding a change of condition, diagnostic findings, and treatment plans conducted by e-mail, verbally, or by telephone should be routinely noted in the medical record. A brief note indicating the time, date, and content of the conversation is advised.

With ongoing advancements in technology, and an increased focus on care provided in the ambulatory setting, it is anticipated that organizational processes will be developed to enhance ongoing communication amongst all parties, not the least of which is the patient. 


October 1, 2008
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