Streamlining Referrals

Today I came across an interesting study in the Canadian Journal of Neurological Sciences. The abstract can be found here and is worth a read.

In short, the article addresses the issue of over-referral of lumbar spine patients to neurosurgical specialists. The authors found that only 26% of referrals were appropriate, while 30% were uncertain and 44% were inappropriate for surgical assessment.

The authors defend my stance that there is a need for improved, targeted education at the patient and primary care physician levels. The abstract conclusion states, "physicians seeking specialist consultations for patients with lumbar spine complaints need to be better informed of the criteria which indicate an appropriate referral for surgical treatment, namely clinical and radiological evidence of nerve root compression."

Streamlining referrals may initially seem undesirable (who in his right mind wants to decrease the number of referrals to his clinic!?) but upon closer examination it is actually a very strategic move. The article only addresses the issue of over-referrals; under-referral is far more difficult to quantify but is certainly a problem. There are undoubtedly many patients in your community who may actually benefit from surgical treatment but are not being referred.

By giving our referrers a better understanding of surgical indications and treatment options, we can eliminate unnecessary appointments for some patients and improve access to surgical care for indicated patients. From the surgeon's perspective, this can lead to a higher percentage of clinic appointments that result in surgical cases -- less time in clinic, more time in the OR.

Communication + Education = Patient Satisfaction

People ask what I do for a living and I say "practice marketing." It's a quick and easy summary of my overall objective. However, I actually do very little marketing. I'm sure the day will come, but I have yet to do a billboard and I actually do very little print advertising. I am adamant that the best "marketing" tactic available to a good surgeon is education - of both patients and referring physicians.

I found this interesting article from FierceHealthcare that substantiates my claim. Indeed, not only does it seem that patient education upon hospital discharge increases patient satisfaction (and theoretically that patient's willingness to refer family and friends)... but it may also improve outcomes. The study referenced shows a reduction in readmission rates for patients when given very clear discharge instructions.


According to the FierceHealthcare article, Dale Wood, Chief Quality Officer at Charleston Area Medical Center in West Virginia, "credits the success to simplifying discharge instructions; giving patients handouts with important reminders, such as taking their medications, visiting their doctor within 14 days of their discharge, monitoring their weight; and making follow-up calls to patients with a simple phone survey."

While these tactics are geared toward heart failure and pneumonia patients in a hospital setting, the same principals hold true in any practice. We don't always have control over a patient's outcome. There are times when you have no good option to offer a patient. What you can always control, however, is communication. Work with an outside consultant (I happen to know a great one!) or a designated member of your staff to come up with a consistent communication plan for your patients. Offer educational brochures that cover frequently asked questions for common conditions. Have a nurse call each patient to follow up after procedures or important office visits. Create education pads, much like prescription pads, and send each patient home with a list of their medications and customized instructions.

Communication to ensure your patient is well-educated can be the difference between a happy and an unhappy patient.