Improving Referral Communication in the MaineHealth Region

1. Improving Referral Communication in the MaineHealth Region Referral Communication Workgroup May 2002

2. 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

3. MaineHealth Vision Working together so our communities are the healthiest in America.

4. MaineHealth Decision-Making Structure as related to Clinical Integration

5. 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.

6. 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.

7. 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.

8. 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 Causes and Effects of Poor Communication

9. Solutions Clinical Integration Steering Committee formed a Referral Communication Workgroup (RCW) to address these issues and to propose potential solutions.

10. 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.

11. 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.

12. 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.

13. Office-based Tools • Referral etiquette - PCP and Specialist relationships • PCP Guidelines • Specialist Guidelines

14. PCP Guidelines • Clarity regarding reason for referral • Clarity regarding timing/urgency of referral • Transfer of background information before the appointment • Co-management expectations

15. 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

16. Office-based Tools • PCP request for specialty consultation • Quick FAXback form -brief handwritten information pending full report • Specialty consultation follow-up form

17. Referral Communication Forms • May be personalized and customized by practices • Utilize key features to achieve standardization in referral communications in our community

18. PCP sites GPMG Westbrook GPMG Spurwink Intermed Longcreek Scarborough Family Practice Specialty sites Maine Neurosurgery Orthopaedic Associates Portland GI Pilot Site Interventions

19. 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

20. Pilot Site Results Referral 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”

21. 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”

22. 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

23. “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

24. 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

25. 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

26. MaineHealth Vision Working together so our communities are the healthiest in America.