Referrals to specialty consultants are among the many important things that primary care physicians (PCPs) must track in their day to day practice, both within the office and the hospital setting.  Missed or delays in diagnosis and treatment, repeated or unnecessary testing, adverse drug reactions and a host of other problems can result from lack of communication and breakdowns in the coordination of care, and can all increase your liability exposure for failing to supervise  a patient’s case.  These claims, which are occurring far too commonly, typically stem from poorly designed or implemented methods for ordering and keeping track of referrals and knowing whether a patient makes an appointment and keeps it, whether a consult on a hospitalized patient has taken place or whether the specialist has sent you a report.

We often hear PCPs complain that they do not always receive written communication of referral results from specialists when they refer patients.  Conversely, and perhaps more troubling, is that PCPs do not always communicate necessary patient information to specialists when making referrals, and even when they do, the reason(s) for the referral are often absent.  A study funded by the Agency for Healthcare Research and Quality[1] revealed similar results.  This AHRQ study examined how physicians coordinate patient care for specialty referrals and the effects of these activities on specialist feedback, as well as physician’s satisfaction with the specialty care their patients receive. A total of 963 referrals from the offices of 122 pediatricians were reviewed.  The results revealed that referral completion increased three-fold for those referrals in which the PCP actually scheduled a patient’s appointment with the specialist and/or sent information to the specialist compared to those for which neither activity occurred; satisfaction ratings of referring pediatricians increased significantly by any specialist feedback, especially feedback by both telephone and letter; and elements such as presence of patient history, suggestions for future care, follow-up arrangements, and plans for co-management of patients by the specialist and PCP.  All of these components positively improved physician ratings of the quality of specialist feedback.