Purpose
Transition to a value‐based care system involves reducing costs improving population health and enhancing the patient experience. Many rural hospitals must rely on specialist referrals because of a lack of an internal system of specialists on staff. This evaluation of the existing specialist referrals from primary care was conducted to better understand and improve the referral process and address costs, population health, and the patient experience.
Data sources
A 6‐month retrospective chart review was conducted to evaluate quality and outcomes of specialty referrals submitted by 10 primary care providers. During a 6‐month period in 2015, there was a total of 13,601 primary care patient visits and 3814 referrals, a referral rate of approximately 27%.
Conclusions
The most striking result of this review was that nearly 50% of referred patients were not making the prescribed specialist appointment. Rather than finding a large number of unnecessary referrals, we found overall referral rates higher than expected, and a large percentage of our patients were not completing their referrals.
Implications for practice
The data and patterns emerging from this investigation would guide the development of referral protocols for a newly formed accountable care organization and lead to further quality improvement projects: a LEAN effort, dissemination of results to clinical and executive staff, protocols for orthopedic and neurosurgical referrals, and recommendations for future process improvements.
Nurses have both a professional and ethical responsibility to advocate for social justice and vulnerable populations. Immigrants are considered one of the most vulnerable populations in the United States and interact with nurses at all levels of the healthcare system. This article provides a broad overview of immigration and the immigration system in the United States and calls for nurses to practice individual advocacy for immigrant patients at the clinic. Included are practical ways that nurses can advocate for immigrant patients at the systems and state and federal levels.
Since 2019, the global health crisis created by the spread of the COVID-19 coronavirus disease has had widespread human, economic, and social impacts. This crisis has heightened our awareness of preexisting health disparities, the slow pace of bureaucratic decision-making, and the increased demands on our health care systems to access, mobilize, and successfully utilize resources. LiveWell, a nonprofit aging services provider, and Bird’s Eye Medical, a for-profit health care organization, were both adept in their ability to leverage community partnerships to meet critical health care needs in their local communities, demonstrating foresight, creativity, and expandable key practice measures. Bird’s Eye Medical and LiveWell developed innovative, community-based approaches to the COVID-19 pandemic, based on purpose and service to their communities, and took quick action in scientific-based practices while prioritizing the needs of vulnerable populations. Two case studies are examined to answer the question, “What can we learn from the successes of the COVID-19 pandemic, and what shifts could we implement to encourage increased cross-sector collaborations?”
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