Interventions to Improve the Quality of Outpatient Specialty Referral Requests

Hendrickson, Chase D.; Lacourciere, Stacy L.; Zanetti, Cole A.; Donaldson, Patrick C.; Larson, Robin J.

doi:10.1177/1062860615587741

Cited by 11 publications

(8 citation statements)

References 31 publications

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“…The concept of a centralized system is not a new idea, nor is it something foreign to the health care system in Canada. In the United Kingdom, pooled specialist referrals have been in use for well over a decade [ 1 ]. Previously, a ‘Choose and Book’ method was attempted in England whereby PCPs triaged Otolaryngology referrals and they themselves booked their patients into consultant clinics [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…In Canada, specialists rely heavily upon primary care physicians (PCPs) as the main source for their referral base. Although variable among provinces and hospitals, the process typically begins with a PCP requesting specialty consultation [ 1 ]. Research exists that attempted to improve the quality of referrals; however, the results are largely equivocal and the studies were not specific to any one specialty [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the referral preferences and consultation requests of primary care physicians with otolaryngology – head and neck surgery

Scott

Wong

Sowerby

2015

Journal of Otolaryngology - Head & Neck Surgery

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BackgroundNo literature exists which examines referral preferences to, or the consultation process with, Otolaryngology. In a recent Canadian Medical Association nation-wide survey of General Practitioners and Family Physicians, Otolaryngology was listed as the second-most problematic specialty for referrals. The purpose of this study was to learn about and improve upon the referral process between primary care physicians (PCPs) and Otolaryngology at an academic centre in Southwestern Ontario.MethodsPCPs who actively refer patients to Otolaryngology within the catchment area of Western University were asked to complete a short paper-based questionnaire. Data was analyzed using descriptive statistics.ResultsA total of 50 PCPs were surveyed. Subspecialty influenced 90.0 % of the referrals made. Specialist wait times altered 58.0 % of referrals. All PCPs preferred to communicate via fax. Half of those surveyed wanted clinical notes from every encounter. Seventy-four percent of respondents wanted inappropriate referrals forwarded to the proper specialist automatically. Twenty-two percent of those surveyed were satisfied with current wait times. A central referral system was favored by 74 % of PCPs.ConclusionImprovements could help streamline the referral and consultation practices with Otolaryngology in Southwestern Ontario. A central referral system and reduction in the frequency of consultative reports can be considered.Electronic supplementary materialThe online version of this article (doi:10.1186/s40463-015-0114-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluating the referral preferences and consultation requests of primary care physicians with otolaryngology – head and neck surgery

Scott

Wong

Sowerby

2015

Journal of Otolaryngology - Head & Neck Surgery

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“…A systematic review of the quality of outpatient referrals by Hendrickson, Lacourciere, Zanetti, Donaldson, and Larson (2015) evaluated the evidence supportive of quality improvement interventions for specialty referrals. The interventions examined software-based solutions, template-based interventions, and referral management.…”

Section: Quality Improvement Of Referrals In Rural Healthmentioning

confidence: 99%

Evaluation of specialist referrals at a rural health care clinic

Biggerstaff

Short

2017

Journal of the American Association of Nurse Practitioners

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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.

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“…10 Requests for specialty consultation provide an opportunity to study these issues in a vertically integrated health system and find targets for improvement. 12…”

Section: Introductionmentioning

confidence: 99%

Specialty Physician Designation in Referrals from a Vertically Integrated PCMH

Schreiner

Holmes-Maybank

Zhang

et al. 2019

Health Services Research and Managerial Epidemiology

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Introduction: Primary care referrals to specialty physicians once relied upon the medical skill of the specialist, the quality of past communication, and previous consultative experiences. As health systems vertically integrate, patterns of specialty physician referral designation are not known. Methods: This cross-sectional study from a patient-centered medical home (PCMH) evaluated the proportion of referrals with named specialists. All outpatient specialty referrals from the PCMH between July and December of 2014 were eligible for inclusion, and 410 patients were randomly selected for chart review. The outcome of interest was specialty physician designation. Other variables of interest included PCMH provider experience, the reason for referral, and time to specialty visit. Univariate analysis was performed with Fisher exact tests. Results: Of 410 specialty referrals, 43.7% were made to medical specialties, 41.7% to surgical specialties, and 14.6% to ancillary specialties. Resident physicians placed 224 referrals (54.6%), faculty physicians ordered 155 (37.8%), and advanced practice providers ordered 31 (7.6%). Only 11.2% of the specialty referral orders designated a specific physician. No differences appeared in the reason for referral, the referral destination, the proportion of visits scheduled and attended, or the time to schedule between those referrals with and without specialty physician designation. Faculty physicians identified a specific specialist in 21.4% of referrals compared to residents doing so in 4.9% ( P < .0001). Conclusion: Patient-centered medical home referrals named a specific specialty physician infrequently, suggesting a shift from the historical reliance on the individual characteristics of the specialist in the referral process.

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Interventions to Improve the Quality of Outpatient Specialty Referral Requests

Cited by 11 publications

References 31 publications

Evaluating the referral preferences and consultation requests of primary care physicians with otolaryngology – head and neck surgery

Evaluating the referral preferences and consultation requests of primary care physicians with otolaryngology – head and neck surgery

Evaluation of specialist referrals at a rural health care clinic

Specialty Physician Designation in Referrals from a Vertically Integrated PCMH

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