Tracking Referrals & Consultations

A frequently asked question when referrals are made is, “What is my duty as the referring physician to ensure that the patient keeps his/her appointment with the consultant?”  Many physicians do a good job of tracking labs and diagnostic tests, but they do not think about tracking appointment cancellations, no-shows, consultations, or referrals.  Tracking the receipt of lab and diagnostic tests is not enough.  If a test result indicates the need for further follow up with a specialist, you should have a tracking system in place to alert you if the patient fails to keep a scheduled or recommend referral or consultation.   A physician’s duty to a patient may not be discharged just by referring the patient or making an appointment.  Although patients are expected to take responsibility for managing their healthcare, physicians are expected to play a part in ensuring that patients get appropriate care; your medical training gives you a better understanding of the consequences of various treatment options as well as the consequences of delaying treatment. It is important that you have an informed consent discussion with the patient outlining the significance of the findings, why you are referring the patient, and the possible consequences of not following up. Be sure to inform the patient of the risks, benefits, and alternatives if the referral is for a particular test or procedure. Always document your rationale for the referral and document your conversations with the patient. 

A standardized form of communication, such as a referral request form, will help consultants provide appropriate care for your patients and keep you in the loop, making the process run smoothly for everyone. Including your patient in the process is another safety net in the event one of the other systems fail.  SVMIC has a sample Request For Consultation form that may be useful to your practice when requesting a consultation from a specialist.  Your request should include the following information:

• • patient’s name
  • date of birth
  • reason for consultation
  • the degree of urgency
  • pertinent history
  • any specific requests
  • whether you wish to transfer the patient’s care

It’s important to select a specialist with the appropriate skills and training to care for your patient’s condition.  Always inform the specialist of any special circumstances involving the patient and send the appropriate medical records.  In all instances, clarify the role of each physician in the patient’s care.  If the referral is urgent or the condition is serious, a phone call to the physician is indicated.  Have your office staff schedule the appointment before the patient leaves your office, which will dramatically increase the likelihood of patient compliance.  

Once a referral is made, it should be tracked utilizing the same system you use to track a lab or diagnostic test result. If you learn the patient has not kept the appointment, have your office call or send a letter noting your concern and emphasizing the importance of the consult.  Depending on the severity of the issue, a certified letter may be necessary to document your attempt.  On the other hand, if you determine the consult is no longer necessary, document your reasons for the change in opinion.  Finally, train all staff not to file any reports, including consultation reports or letters, without the physician’s review and signature.