Improving Referral Communication in the MaineHealth Region

MaineHealth

Improving Referral Communication in the MaineHealth Region

Referral Communication Workgroup

May 2002

MaineHealth

MaineHealth Hospital Members/Affiliates

1. Miles Healthcare

2. St. Andrews Hospital & Healthcare

3. Maine Medical Center

4. Spring Harbor Hospital

5. Western Maine Healthcare

6. Southern Maine Medical Center

7. Mid Coast Hospital

8. MaineGeneral Health

9. Sisters of Charity Heath System

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MaineHealth Vision

Working together so our communities are the healthiest in America.

MaineHealth

A s th m a C a rd io va scu la rH e a lth

D ia be tes ReferralCom m unication

W o m e n 'sH e a lth

D e p ress ion

C lin ica lIn teg ra tio n S te ering

C o m m ittee

M H M a n a g em e ntT e am

M H B o a rd o f T rus te es

MaineHealth Decision-Making Structure as related to Clinical Integration

MaineHealth

The Problem

A recent physician survey and review of

medical literature show that there is

significant need to improve the exchange of

clinical information when a patient is

referred for specialty consultation.

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The Problem for PCP’s• 45% of PCP’s reported that they do not

receive appropriate follow-up information from specialists after a referral.

• 12% are “very satisfied” with the information they currently receive.

• Only 8% are satisfied by their current ability to book patients in an acceptable period of time.

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The Problem for Specialists

• 68% of specialists reported that they do not receive adequate clinical information on patients referred to them.

• 1% were “very satisfied” with the information they are currently receiving.

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Causes and Effects of Poor Communication

• It’s difficult to access patient information: it comes from different sources (e.g. lab, imaging)

• Physicians may be unaware of the problems

• Practices already face heavy administrative demands

• Provider dissatisfaction

• Patient dissatisfaction

• Practice inefficiencies, redundant testing, wasted resources

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Solutions

Clinical Integration Steering Committee

formed a Referral Communication

Workgroup (RCW) to address these issues

and to propose potential solutions.

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Referral Communication Goals

Promote quality patient care, improve

efficiency, and improve provider and

patient satisfaction by cultivating

relationships and supporting effective

communication between PCP’s and

specialists.

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Referral Communication Efforts• Identify current “best practice” groups that

demonstrate excellent specialist/PCP relationships and communication.

• Develop recommended standards to help build PCP-specialist relationships.

• Develop recommended clinical communication standards for both PCP’s and specialists when making specialty referrals.

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Referral Communication Efforts

• Develop practical office-based tools to improve clinical communications.

• Identify pilot sites to test ways to improve communication processes. Measure outcomes and refine recommendations and tools.

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Office-based Tools

• Referral etiquette - PCP and Specialist relationships

• PCP Guidelines

• Specialist Guidelines

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PCP Guidelines

• Clarity regarding reason for referral

• Clarity regarding timing/urgency of referral

• Transfer of background information before the appointment

• Co-management expectations

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Specialist Guidelines

• Office system in place for emergent/urgent consultation requests

• Timely communication of information back to PCP- Quick FAXback form for emergent/urgent consultations, all within 1 week

• Co-management recommendations

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Office-based Tools

• PCP request for specialty consultation

• Quick FAXback form -brief handwritten information pending full report

• Specialty consultation follow-up form

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Referral Communication Forms

• May be personalized and customized by practices

• Utilize key features to achieve standardization in referral communications in our community

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Pilot Site Interventions

• PCP sites– GPMG Westbrook

– GPMG Spurwink

– Intermed Longcreek

– Scarborough Family Practice

• Specialty sites– Maine Neurosurgery

– Orthopaedic Associates

– Portland GI

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Pilot Site Results

12 of 15 participating PCP’s and staff agreed or strongly agreed that using referral communication form…

– Helps ensure correct information is sent when referring patients to specialists

– Improves efficiency of sending clinical info when making a referral

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Pilot Site ResultsReferral communication form helpful because…• “It takes the guesswork out of the diagnosis”• “Everything needed is on one form”• “Making appointments is easier”• “Appropriate diagnosis information and test or consult

very well defined”• “Uniform method of assuring appropriate info gets sent” • “ It speeds up the process”• “Easy to use”

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Pilot Site Results

Specific ways communication form has helped my practice…

• “Helped to make appointments easily”• “Great for clinical and referral staff”• “Appointments can be made and referrals in smooth

and organized manner”• “Helps to catch possible missed steps”• “Assures proper information gets sent” • “All the doctors need to use these forms”

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RCW Implementation Plan• Presentation of tools

– Medical Staffs– PCP and Specialty Groups

• Provision and utilization of tools– Download from floppy disc– Web-based access (www.mainehealth.org)

• Best Practice Awards as recognition for compliance

• Revision of tools/upgrades

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“Best Practice” Recognition

• Internal survey tool

• Internal audit

• External validation

• Rewards and recognition– Staff lunches or theatre tickets– Publications, e.g. hospital newsletters– Best Practice plaque for waiting room

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The Old Way• Frustration about getting timely

consultation

• Patients arrive for consultation with inadequate background information

• Variation in getting timely information back to the PCPs by the specialists

• Specialists assume co-management responsibilities without PCP approval

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The New Way• Specialist office systems to accommodate all

consultation requests, even emergent/urgent

• Full background information available before patients is seen by consultant

• Timely return of information from specialist back to PCP

• Clear communication about shared co-management responsibilities between PCPs and specialists

MaineHealth

MaineHealth Vision

Working together so our communities are the healthiest in America.