Referrals represent demand for a practice’s services generated by another clinician inside or outside Mass General Brigham. The demand is unmet until the referral becomes a scheduled appointment. Lag time between referral and appointment scheduling creates delays in patient care and increases the likelihood that the referral will be lost to a competitor.
Epic is the primary online system for creating and managing referrals from Mass General Brigham practices. Referrals are generated when the referring clinician creates a referral order in Epic indicating the patient’s reason for referral, and any details they would like to share with the consulting clinician. The referral order enters a scheduling workqueue (WQ) that is managed by the practice/clinician receiving the referral.
Referrals received in Epic WQs come from one of the following sources:
- An MGH department (e.g., MGH Internal Medicine Associates)
- A Mass General Brigham entity (e.g., Brigham and Women’s Hospital Primary Care)
- A non-Mass General Brigham entity via Physician Gateway (e.g., Beth Israel Deaconess Cardiology)
Your practice’s ability to meet defined goals for referral response and scheduling impacts the ability to meet volume and patient experience targets. The three options for responding to each incoming referral are:
- Schedule an appointment.
- Return referral to referring clinician without scheduling.
- Return to referring clinician after cancellation/no-show.
- Check referral WQs several times a day and respond in appropriate time:
- Respond to urgent referrals (those requiring an appointment within 3 days) immediately (as defined by practice).
- Respond to incoming referrals within 2 business days.
- Respond to returned referrals within 7 business days.
- Maintain a documented referral management plan that includes sign-off by a clinical staff member. The referral management plan should include:
- Protocols for handling urgent, incoming, and returned referrals within the appropriate time ranges as listed above
- Documented decision support algorithms, vetted by clinical leadership, for differentiating urgent and non-urgent clinical issues
- An escalation process tied to the practice’s urgent-access protocol for cases where appointment availability does not support the protocol.
- Conduct weekly reviews of Epic referral WQ productivity and returned referral reports.
- Conduct daily reviews if standards are not regularly met.
- Always schedule from the Epic referral WQ when a referral is available.
- Always enter the referring clinician’s name into the Referral Source field during the scheduling process.
- Review referral orders at least twice a year to ensure accuracy and efficiency for the referring clinician and intake/scheduling staff.
- Assign a dedicated referral staff or at least 1 full-time employee with dedicated time to manage referrals.
- Transcribe all referrals received via phone, fax or email into Epic. See the tip sheet for instructions.
- Contact the referred patient within 1 to 2 business days based on urgency level.
- If the patient does not respond, contact them again in 3 to 5 business days.
- If patient still does not respond, close the referral within 7 business days.
- Review Epic WQ productivity and performance reports at least weekly (practice manager responsibility).
- Review and update the Practice Referral order once a year to increase efficiency for referring practice and referral/scheduling staff.
- Time first and second attempts to reach a patient according to urgency level:
| Priority | Step 1: First Attempt to Contact Patient |
Step 2: Second Attempt to Contact Patient |
Step 3: Assign or Return Referral to Practice using “Unable to Contact” Status |
|---|---|---|---|
| Urgent: Respond within 2 weeks | Within 1 day | 2 days after 1st attempt | 2 days after 2nd attempt |
| Routine: Respond within 1 month | Within 2 days | 3 days after 1st attempt | 3 days after 2nd attempt |
Return referrals occur when patients cannot be reached to schedule an appointment or choose not to be seen. In these cases, you should return the referral to the referring practice via a Workbench Report in Epic; the referring practice will determine whether to follow up with the patient or refer out again.
To access a Workbench Report in Epic, go to PHS AMB REFERRAL TRACKING BY LOGIN DEPT – INCLUDE PT, OT, NUTRITION. The report includes a list of all active referrals sent from a practice and has filters that allow you to monitor the status of your referrals.
See the Running the Referral Tracking Report Tip Sheet for more details on running, customizing, sorting and filtering this report.
A referral order should contain enough information for scheduling, but not so many requirements and details that it is difficult for referring clinicians to use. Referral orders generated in Epic are routed to WQs based on the order setup. It is important to understand your new patient triage and scheduling process and how staff should interact with the queue.
- Use the DEFER function to identify what referrals should be acted on immediately (i.e., day of referral) and what referrals do not need immediate action. See the Referral Workqueue Management Tip Sheet for working referrals.
- Use fields in the WQ, such as Referred to Provider, User Assigned To, and Scheduling Status, to delegate responsibility and view progress.
- Use the Notes section in the referral to communicate with other members of your practice and to the referring practice.
- Work unscheduled referrals in a timely manner.
- Use the WQ to track all incoming referrals; this includes transcribing orders sent via fax, efax, phone or other sources.
- Staff the referral line/WQ so that hospital-wide referral standards can be met.
Use the information in the Ambulatory Dashboard WQ Performance Report to see if you are above the maximum backlog for your area. All referrals should be cleaned out of the workqueue within 8 days.
Links
- Referral Workqueue Management Tip Sheet
- 1. Getting Started with Referral Scheduling WQs Tip Sheet
- 2. Creating an Orders Only Encounter for a Referral Tip Sheet
- 3. Managing WQs, Updating Statuses, Creating Notes Tip Sheet
- 4. Transcribing Referrals Received via Phone, Fax, or Email Tip Sheet
- 5. Running the Referral Tracking Report Tip Sheet (Epic Workbench Report for managing return referrals: PHS Amb Referral Tracking by Login Dept – Include PT, OT, Nutrition)
- Ambulatory Dashboard: WQ Performance Report
- Urgent Referral Resources
- Prioritizing Referral Workqueues Tip Sheet
- Cleaning Up Your Referral Workqueue Backlog video
Training
- Front desk referral training is available in the Front Desk Training Track for all new employees.
- Nurses involved in referral management/triage should request the Cadence Referral WQ Access role in Epic.
- A high-level overview of referral management for front-line staff is included in Ambulatory Administrator Onboarding.
Problem
The department was facing some staff attrition and was concerned about maintaining their success in managing their referral workqueue (WQ).
How They Achieved Success
- Fully leveraged Epic’s WQ functionality
- Created and followed written guidelines for referral management (differentiating between urgent and routine referrals)
- Utilized templates to easily identify where new patients should be scheduled
- Dedicated staff for WQ management
The department contacted the Practice Improvement Division to collaborate on how to limit the impact of the departure of 2.5 full-time employees (FTEs). The importance of an efficiently managed WQ directly relates to new patient access to clinicians. If the WQ is not managed properly, patients will have more wait days before their appointments, and urgent appointments may be delayed. This, in turn, could negatively affect patient experience and health outcomes.
Actions Taken
- Worked with the PI Division’s Center for Ambulatory Services (CAS) to handle the WQ
- Changed workflow so that CAS now handles routine referrals and the department manages urgent requests
Results
Dermatology’s partnership with CAS maintained their positive performance in WQ management and enabled the department not to fill a vacant FTE position. This positively impacted the department’s budget with no impact on the patient experience, patient access or staff workload.