PRIMARY CARE TEAM TOOLKITS
Enhanced Referrals
Closing the Loop: A Guide to Safer Ambulatory Referrals in the EHR Era
Institute for Healthcare Improvement / National Patient Safety Foundation. Closing the Loop: A Guide to Safer Ambulatory Referrals in the EHR Era. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017.
Specialty referrals — when a clinician refers a patient to a specialist for evaluation or treatment — are on the rise in the US, increasing from 40.6 million in 1999 to 105 million in 2009. Yet, despite the advent of electronic health records (EHRs), the referral process is often hindered by ambiguity of roles, communication breakdowns, clinicians’ workloads, and variations in requirements among specialists. Such difficulties can lead to missed or delayed diagnoses, delays in treatment, and other lapses in patient safety.
The recommendations outlined in this publication are designed to help standardize the ways in which primary care practitioners activate referrals to specialists, and then keep track of the information over time.
This publication describes a nine-step, closed-loop process in which all relevant patient information is communicated to the correct person through the appropriate channels and in a timely manner. As the process involves significant collaboration among all stakeholders, the publication includes both general recommendations as well as recommendations specific to each step in the process and each stakeholder group.
This work was supported by a grant from CRICO/Risk Management Foundation of the Harvard Medical Institutions.
Closing the Referral Loop: an Analysis of Primary Care Referrals to Specialists in a Large Health System
NIH
“Ideally, a referral from a primary care physician (PCP) to a specialist results in a completed specialty appointment with results available to the PCP. This is defined as “closing the referral loop.” As health systems grow more complex, regulatory bodies increase vigilance, and reimbursement shifts towards value, closing the referral loop becomes a patient safety, regulatory, and financial imperative. To assess the ability of a large health system to close the referral loop, we used electronic medical record (EMR)-generated data to analyze referrals from a large primary care network to 20 high-volume specialties between July 1, 2015 and June 30, 2016.”
