“Our research shows the actual location where people are being harmed and that’s in the outpatient setting more often than in hospitals, the overwhelming majority of health care in the United States is delivered outside of hospitals and we cannot assume that medical errors in outpatient settings are less harmful than those in hospitals.” Robert L. Phillips, Jr., MD, assistant director of the Graham Center.
Physicians must talk to each other when they hand a patient off to another physician or caregiver. Physician hand-offs occur both in hospitals (inpatient) and outpatient or ambulatory care. Inpatient hand-offs between caregivers can be managed because the caregivers are under a single management authority that can define and implement policies and usually have access to a common information system. The Joint Commission’s National Patient Safety Goal 2e addresses inpatient hand-offs when they audit hospitals to determine their ability to provide quality care.
Ambulatory care patient hand-offs are harder to address and improve because physicians operate practices that are independently owned and managed, are dispersed geographically, and use a variety of information systems. The Joint Commission also has goals that apply to ambulatory care hand-offs as well as other organizations like the Accreditation Association for Ambulatory Health Care (AAAHC/Accreditation Association). Many studies have been completed that highlight the issues with coordinating care between ambulatory physicians.
“In an outpatient setting hand-offs are documented by an order or referral. Referrals are a key outpatient transition of care. Facilitating transmission of referral information electronically can improve physician communication. Substantial problems are present in the referral process. The major issues were physician dissatisfaction, lack of timeliness, and inadequate content of interphysician communication. Efforts to improve the referral system could improve both physician satisfaction and quality of patient care.” Tejal K. Gandhi, MD
Analysis of malpractice claims reveal two areas where referring physicians have preventable malpractice risk: identifying and following up on non-compliant patients and “closing the loop” or matching a report back to every order.
Referral Management
Referral management must include at least three separate services:
· Enter all orders and referrals, to any specialist and to any healthplan and build a log of all orders and referrals
· Call patients and remind them to make an appointment with the specialist and generate alerts when people are non-compliant
· Capture all consult reports, match with orders/referrals and generate alerts when reports are late.
Referalink manages ambulatory patient hand-offs between physicians today using information systems and communication currently available to most providers. Both the physician making the referral and the physician receiving the referral have a financial benefit or incentive to use the Referalink Network as well as providing better patient care and reducing malpractice risk.
