Page 5 - Risk Reduction Series Effective Systems Part 2

SVMIC Risk Reduction Series: Effective Systems

Part Two

Referral Management

Referrals to other physicians for consultation or second opinions

are an important part of a medical practice. The failure to
send the patient for consultation, the failure of a patient to

go to a consultation, or the failure to act on the consultant’s
recommendations are the bases of many legal actions against

physicians.
1

Referrals from primary care practitioners to specialists are

fraught with uncertainty and inefficiency. As many as half of
2
the approximately 100 million referrals ordered each year in

the U.S. are not completed: patients opt out, scheduling gets
3
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. Beyond inefficiency, mishandled referrals represent
4
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/

1 Thomas, M. O., Quinn, C. J., & Donohue, G. M. (2009). Practicing medicine in difficult times:
protecting physicians from malpractice litigation. Sudbury, Mass.: Jones and Bartlett Publishers
2 Weiner M, Perkins AJ, Callahan CM. 2010. Errors in completion of referrals among older urban
adults in ambulatory care.. 6(1):76–81
3 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
4 Hoffman, Jock. Toward an Ideal Referral Process, CRICO podcast, November 29, 2017

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