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Efficiently and Effectively Handling Referrals & Transitions of Care

Patient care gaps are created when we fail to follow up with patients referred to specialists, sent for a diagnostic test, or recently prescribed medication. 

To mitigate these gaps, clinical pediatric care providers should be taking the time to focus on transitions of patient care and the referrals that drive them. How can you most efficiently and effectively handle these workflows?

Understanding Referrals and Transitions of Care

Let’s first define both referrals and transitions of care, and explain why they are different. 

A referral is something driven by the provider or care team member. For example, that would be a provider saying “Mom, you need to take your child to another provider for this specific reason.” 

A transition of care is different. Here, the parent or caregiver has decided on their own to take the patient to another provider for a specific reason. Typically, it is up to this new provider to forward a report with information about the visit and the services provided as well as outcomes back to the original provider. An example of a transition of care could include a patient going to the emergency room or visiting an urgent care clinic.

As the primary care provider, we need to follow up on both referrals and transitions of care, to ensure that everything is progressing smoothly and there is continuity of care.

Best Practices for Handling Referrals

Both referrals and transitions of care follow a similar workflow, even though they originate differently. 

The care coordinator, provider, or whoever manages the full patient care team in your practice should be following up every referral with either the parent or the specialist. For example, “We sent you a patient who was seen over three weeks ago, and we still haven’t gotten the report.” 

In either case, someone in your office should be following up to ensure the patient’s specific needs are being addressed, not just their primary care needs. 

Success Story – The Proof 

I can tell you about one instance that really hits home with me, which illustrates the importance of correctly managing referrals and transitions of care.

A new patient came into our office for a routine well visit after recently moving into the area. The patient’s mother mentioned that her son didn’t have his normal energy and just didn’t seem as active as he’d been before. After blood work showed his glucose levels were low, our practice referred him to an endocrinologist, who was able to see him almost immediately. 

It turned out that the patient had been suffering for about two years with undiagnosed juvenile diabetes. This boy is now a young man who manages his diabetes and lives an active lifestyle.

Taking that extra step for a referral and having an efficient workflow through the referral process was crucial in treating him successfully.

The Role of Your EHR

No matter what the insurance circumstances are, or whether or not authorization is needed for a referral, a pediatric EHR will support your patient care. It does this by: 

  • Generating the referral
  • Transmitting the referral (through email or phone) in the visit summary

After this, it’s the responsibility of your practice, whether through the care coordinator or provider, to follow up and monitor the referral.

This is where a pediatric EHR supports the real-world work that your practice does to make sure that the parent took the child to the referral provider. 

All the monitoring of the referral, reporting, and reminders can take place through the EHR. Ideally, we wouldn’t have to follow up in every instance, and we always hope the referral provider will return a report promptly. 

Either way, when the report is received, it will immediately be attached to the patient’s referral list in the patient’s EHR. This closes the loop and seamlessly provides information about the outcome, including care recommendations, medications, and any additional referrals and follow-ups.

Maximizing Workflows

With the correct EHR, maximizing the workflow of a referral or transition of care is simple and easy. However, the biggest missed opportunity we’ve noticed among EHR users is the failure to leverage the flag date for an outgoing referral. 

Instead of needing to use an external system for reminders, providers can leverage their EHR by using the flag date feature. As long as you have reasonable expectations about referrals and set an effective flag date for when you expect reports to return, you can use this useful feature to maximize your efficiency and streamline your workflow. 

This is a powerful way to help to maximize your care, and it can help you use these administrative tools to address the whole child along with their primary care needs. 

A pediatric EHR has many useful and effective functions, but the workflow for handling referrals and transitions of care is what makes it such an invaluable asset for pediatric practices around the United States. These features make it easy for both practitioners and patients, streamlining care and catching critical gaps that otherwise may have gone unnoticed. 

Can your EHR offer the same functionality? If not, you should explore your options. 

BJ Bloom, RN, IBCLC
bjbloom@officepracticum.com


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