Page 45 - 2022 Risk Basics - Systems

SVMIC Risk Basics: Systems

Referrals from primary care practitioners to specialists are fraught with

uncertainty and inefficiency. As many as half of the approximately 100
8
million referrals ordered each year in the U.S. are not completed: patients
9
opt out, scheduling gets jumbled, critical information is either not sent or
not received, communication breaks down, and the systems relied upon

are incompletely designed to keep track of what did or did not transpire.
10
Beyond inefficiency, mishandled referrals represent mistakes that can

hurt and kill patients through missed or delayed diagnoses, delays in
treatment, and other lapses in patient safety. Unlike tracking systems

for lab and diagnostic imaging, which have received much attention,
emphasis on tracking referrals is lagging behind.

To address a concern of this scale and potential for patient harm, CRICO

and the Institute for Healthcare Improvement/National Patient Safety
Foundation joined forces to convene a panel of experts (including EHR

vendors) and produced a comprehensive outline of practical steps
organizations can take to reduce the risk of referrals-related medical

errors. That document, Closing the Loop: A Guide to Safer Ambulatory
Referrals in the EHR Era, identifies nine potential patient safety
11
gaps in the referrals process, along with the expert panels’ specific
recommendations for closing those gaps. An illustration of the Nine Steps

of the Closed-Loop EHR Referral Process is shown in this figure:
Technology has the potential to significantly improve this process, but it’s

not going to be the only way. The referral process brings opportunity for
error, so if your process isn’t working effectively, adding technology to it

is likely not going to help. According to CRICO’s national Comparative
Benchmarking System (CBS), 23 percent of outpatient cases filed

8 Weiner M, Perkins AJ, Callahan CM. 2010. Errors in completion of referrals among older urban adults in
ambulatory care.. 6(1):76–81
9 Barnett ML, Song Z, Landon BE. 2012. Trends in physician referrals in the United States, 1999–2009. Archives
of Internal Medicine. 172(2):163–170
10 Hoffman, Jock. Toward an Ideal Referral Process, CRICO podcast, November 29, 2017
11 http://www.ihi.org/resources/Pages/Publications/Closing-the-Loop-A-Guide-to-Safer-Ambulatory-Referrals.
aspx

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