Improving Referral Communication Using a Referral Tool Within an Electronic Medical Record

Abstract

Objectives: Poor outpatient referral communication is an important quality and safety issue. We implemented an electronic referral tool to analyze its impact on communication between primary care physicians (PCPs) and specialists. Methods: We studied one practice site that implemented the referral tool and one that did not and surveyed affiliated specialists, PCPs, and patients about referral communication. Results: Specialists more often received information before the referral visit from intervention PCPs versus nonintervention PCPs (62 percent vs. 12 percent, P <0.0001), a finding that persisted after adjustment (OR = 3.3, P = 0.008). Intervention PCPs more often received return communication from specialists (69 percent vs. 50 percent, P = 0.08), a finding of borderline statistical significance. Finally, patients of intervention PCPs were more likely than patients of control PCPs to report that specialists had received information before their visit (70 percent vs. 43 percent, P = 0.007). Conclusion: Referrals are a key outpatient transition of care. Facilitating transmission of referral information electronically can improve physician communication. Introduction Communicating patient information at the time of specialty referral is essential to high-quality consultation and coordinated, safe patient care. Both primary care and specialist physicians value this information exchange for shared patients, but dissatisfaction with the current referral process is widespread among primary care physicians (PCPs) and their consultants. 3, 4 About half the time, the reason for dissatisfaction is a delayed or missing referral letter and reports. Other reasons include dissatisfaction with redundancies in the referral process, missing information in the referral communication, time required to write a referral note, and difficulty in finding a specialist. 4, 5, 6, 7, 8, 9 Studies have highlighted the problem of poor communication between PCPs and specialists in terms of timeliness and content. This represents a major opportunity for improvement. 10 Strategies for improving communication of referral information have been proposed, including scheduling the specialist appointment from the referring physician’s office and providing pertinent information to the specialist, which have been shown to increase referral completion. Specialists who received timely patient referral information reported providing optimal care twice as often as specialists who did not. Other studies have looked at the benefits of physician