Page 46 - 2022 Risk Basics - Systems

SVMIC Risk Basics: Systems

from 2012– 2016 with a missed or delayed diagnosis (N=2,521) had a

breakdown in referral management. Nearly three-quarters (73 percent) of
those patients suffered a high-severity injury or died.
12

The goal is to create a closed-loop referral process. This is one in which

all patient data and information that require action are communicated
to the right individuals at the right time through the right mode of

communication to allow for review, action, acknowledgment, and
documentation. Simply stated – physicians need a highly reliable referral

process that ensures the patient doesn’t fall through the cracks. There
are unique hurdles in an outpatient referral system versus the hospital

consultation system. In the hospital, a consult is ordered, and typically,
the specialist is at the bedside within the day. Outpatient treatment is

often chronic and unfolds slowly, so completing the referral process takes
longer.

Many physicians have a referral system that fails to close the loop
because the patient didn’t keep the appointment. This is frustrating for

the physician, especially in the face of screening guidelines that may
be more challenging to effectively track. Patients may consider these

tests “optional” and frequently cancel appointments. However, there
are often very good reasons why a patient missed the appointment.

The patient may have started feeling better, had no transportation, had
childcare issues, or developed financial concerns or other fears. The most

significant issue is that the patient is unaware of the importance of the
referral or consequences of the missed appointment. It is not a priority

for the patient because there was a miscommunication. Some of these
issues can be addressed by reviewing and evaluating your practice’s

referral process. The referral process should be a shared decision-making
conversation by engaging the patient and agreeing to the plan. There is

12 Hoffman, Jock. Toward an Ideal Referral Process, CRICO podcast, November 29, 2017

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