Primary Care Practices and Specialists Work Together to “Close the Loop” on Referrals; New IHI Guide on Safer Referrals

December 26, 2017 | Strategic Insights for Ambulatory Care


​Beginning in 2013, the Wright Center for Graduate Medical Education, a community-based graduate medical education consortium and primary care network based in northeastern Pennsylvania, set a goal of improving processes for patient referrals, specifically "closing the loop" on all referrals. “We were not trying to build something new; we were trying to streamline and simplify the process that already existed," said Jignesh Sheth, MD, MPH, clinical faculty, Scranton Temple Residency Program, speaking on December 13, 2017, at the Institute for Healthcare Improvement (IHI) National Forum in Orlando, Florida. Partnering with PCPI®, a membership organization that leads programs to improve patient safety, the Wright Center first created “dyads," which were connections between each participating primary care provider and a specialist. Each provider and specialist met to discuss expectations, determine the best ways to communicate between facilities, and formalize "shared care compacts" to enhance communication and coordination. The biggest challenge the Wright Center faced, according to Sheth, was electronic health record (EHR) compatibility; nine different EHRs were used among 12 partnerships of providers and specialists. To overcome challenges, providers used positive "workarounds" in the EHR (e.g., providers always included the clinical reason for referral, even if there was not a structured field for this information), engaged EHR "super users" from each facility who understood the EHR workflow and identified solutions, and enhanced communication between providers and specialists using direct-messaging features.

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