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Pooled Referrals - Guide for Referring Health Providers

Patient
It was not hard to convince the gynecologists that this was a good thing. It provides a steady stream of appropriate referrals to every office in the department. It also matches the flow of referrals to the capacity of the specialist and if there is excess demand, it spreads it evenly through the department.

-Dr. Corrine Jabs, Gynecologist, Regina

Improving Patient Access to Care

When a group of specialists pool their referrals, they assign the patient to the next available consultant within the group who is able to treat the referring condition.

Referral forms are available in both provincial EMRs or by faxing a request to
1-855-355-1921. Specialists will notify your office of acceptance of the referral within 10 days of receipt.

Choosing the pooled referral option improves your patients' access to specialty care by assigning them to the next available specialist. This approach works because it maximizes the use of all the specialists within a group evenly. The United Kingdom's National Health Service has demonstrated that pooling referrals improves patient access to health care and can sustain wait time reductions.

Pooled Referrals: Implementation Guide for Specialists (36-page PDF)

It's About Choice

Patients now have choices. They can choose to see the specialist they saw before. They can ask for a specific specialist. Or, for the first time ever, a patient can ask to the see the next available specialist. Recent data for the Saskatchewan groups using pooled referrals is demonstrating that pooled referrals is a very popular choice among patients.

Health care providers continue to be able to refer patients directly to any specialist within the group, if that is the preference. The pooled referral option is there for patients who want the earliest possible elective or urgent appointment.

A patient who chooses a specific specialist gives up the possibility of shortening their wait time if another qualified specialist could have seen them sooner.

 

Groups that are pooling referrals

Specialists Fax Number
Regina  
CVT Associates * (cardiovascular and thoracic) 306-766-6920
Regina Qu'Appelle Health Region  
   Department of Obstetrics and Gynecology 1-855-355-1921
   Regina Spine Pathway Clinic
306-766-7551
Saskatoon  
Obstetrics and Gynecologic Consultants 306-653-5383
Saskatoon Health Region  
   Department of Cardiology 1-855-355-1921
   Department of Gastroenterology 306-966-7996
   Department of Hematology*  
   Saskatoon Spine Pathway Clinic 306-655-8951
   Orthopedic Hip & Knee* 306-655-8236
   Child Psychiatry 1-888-355-1921
   Neurosurgery (coming soon)  
Saskatoon Foot and Ankle Clinic 306-244-4545
Thoracic Surgeons 306-655-5771
Urology Associates 306-653-4386
Vascular Surgeons* 306-653-8832
Moose Jaw  
Department of Obstetrics and Gynecology 1-855-355-1921
North Battleford  
Obstetrics and Gynecology 306-446-5055
Prince Albert  
Department of Orthopedics 306-953-8976
Department of General Surgery 1-855-355-1921
* Do not use a standardized referral form.

Impact on Providers

Pooled referrals essentially standardize the referral process and help make quality care readily available to everyone. Family providers will know that the entire group or department is involved in improving access by leveling workloads. They can confidently refer to the group or department as a whole and know their patient will see an appropriate specialist. Also, new family doctors no longer have to guess who does what and how long the wait lists are at different offices. Similarly, new or departing specialists are automatically accommodated within the referral process.

Many groups using pooled referrals have adopted a new standard referral form. The referral forms were developed in consultation with primary care providers and designed to work very quickly and efficiently with an electronic medical record (EMR) system. In most cases, you need only check several boxes before sending the referral on.

The new referral forms are designed to help guide your referral to the right specialist and it works well when supported by a referral letter. The form is the minimum set of standard data required to assign patients appropriately. Physicians are encouraged to include a referral letter as well as diagnostic imaging and lab results or any other relevant information about the patient. This information can be sent with the referral form or if you prefer, can be forwarded directly to the specialist's office (once the specialist is known, in the case of pooled referrals). To simplify the referral process, the same standard referral form is used when making either a pooled referral or a direct referral to a specialist within the group.

How to Make a Referral

Pooled referrals are intended for urgent and elective consultations only. For all emergent situations, please contact the specialist on call.

For specialist groups using the standard referral form, please use this form for both pooled and direct referrals. Please note that incomplete referral forms will be returned to the referring practitioner for clarification. If the referral requires clarification and the condition is marked urgent, the form will be forwarded to the specialist concurrently. Completed forms will receive notification of the receipt of the referral within 10 business days.

Submitting a Standard Referral Form
Via EMR Paper Form via Fax
1 Select the appropriate form in your Optimed, Med Access or CMA Practice Solutions EMR. Complete the patient information section. It is very important that you include all of the patient contact telephone numbers. The specialist office needs these numbers to be able to contact the patient.
2 (automatically completed) Complete the referring physician section. Enter the clinic name, address and fax number of the physician who is making the referral.
3 With your patient, determine if they wish to see a particular specialist or if they would prefer to receive the next available appointment with any specialist within that group. Patients and physicians can exclude specific specialists in a pooled referral by documenting those names on the form. If you select the specialist that the patient has seen before or a specific specialist you must include the name of the specialist being requested. With your patient, determine if they wish to see a particular specialist or if they would prefer to receive the next available appointment with any specialist within that group. Patients and physicians can exclude specific specialists in a pooled referral by documenting those names on the form. If you select the specialist that the patient has seen before or a specific specialist you must include the name of the specialist being requested.
4 Select the primary reason for referral. Please select only the primary concern. For pooled referrals, this will help determine the correct specialist to forward the referral to. If you select more than one condition, please circle the most pressing condition. For complicated situations, you are encouraged to attach a more detailed referral letter. Select the primary reason for referral. Please select only the primary concern. For pooled referrals, this will help determine the correct specialist to forward the referral to. If you select more than one condition, please circle the most pressing condition. For complicated situations, you are encouraged to attach a more detailed referral letter.
5 Attach any relevant diagnostic imaging, lab results or other important patient information to the patient referral form. Alternatively, you can send these directly to the specialist's office. If you have selected to pool the referral you will learn the name of the specialist within ten days. Attach any relevant diagnostic imaging, lab results or other important patient information to the patient referral form. Alternatively, you can send these directly to the specialist's office. If you have selected to pool the referral you will learn the name of the specialist within 10 days.
6 Sign the referral form. Sign the referral form.
7 Send the form to the fax number listed at the top of the form. Send the form to the fax number listed at the top of the form.

The Advantages of Pooled Referrals

Pooled referrals provide patients with more choice when being referred to a specialist. They also ensure that every referral consistently reaches an appropriate consultant.

Keeping patients informed about their referral is an important step toward improving the patient experience. It reduces the anxiety often associated with waiting and not knowing. This will means fewer phone calls to your office from patients asking about the status of their referral.

You will have peace of mind knowing that your referral has reached a specialist who is able to treat the referring condition. You will also know when your patient will be seen. Many pooled referral groups will confirm acceptance of the referral with your office within 10 business days. Within two weeks, most specialists' offices will notify you and your patient of their appointment date or when they can expect to receive an appointment date.

It's about Efficiency

This approach to managing patient referrals aligns with the goals of the Saskatchewan Surgical Initiative by ensuring that referrals consistently reach appropriate specialists and patients are able to receive the earliest available appointment time. It improves the surgical patient experience by offering more choice to the patient and the referring practitioner. It also improves communication at critical points in the referral process.

Historically, confirmations were made by specialists approximately one month prior to the consult. This means for a specialist with a 12-month wait list, the patient would not receive confirmation for 11 months. With the new referral process, many participating specialists will confirm acceptance within two weeks of receiving the referral form.

Overall, pooling referrals will reduce wait time variability among a group, which will shorten the overall wait time for treatment for many patients.

It’s about Sustainability

The pooled referral process was developed using Plan-Do-Study-Act (PDSA) cycles. It is a process of developing and implementing a plan, observing the plan (or process) in action, learning from its consequences and modifying the plan accordingly to achieve the desired outcome. Feedback from patients and physicians are collected at each stage of change to ensure the desired outcomes are being achieved and opportunities to improve upon the existing plan are incorporated. This then enables a process of continuous quality improvement.

Groups participating in pooled referrals will also be gathering data about the number of patients their group sees, the types of conditions that are being referred, and how long each patient waits to be seen. Specialists will thus be provided with important information to help them continually improve how they deliver their services. The information also allows partners in the health system to better gauge the demand for different specialists and plan to ensure there are enough of the right kind of specialists in Saskatchewan to meet the needs of the population.

Common Questions

Q - Why do some referral forms ask for formal patient consent? Has something changed with the introduction of pooled referrals?
The means of collecting consent to refer a patient to a specialist remains unchanged. The intent of this section is to ensure that patients are made aware of the new pooled referral process. We have learned that this part of the referral form has caused some confusion and it will be revised in the near future. In the meantime, only your signature is required to confirm the information is correct and referral consent was collected.

Q - My patient wants to use the pooled referral option but had a prior bad experience with one of the specialists in the group. Is there any way I can use pooled referrals without including that specialist in my referral?
Yes. The new referral process is intended to increase patient choice and improve the patient experience. The next version of the referral form will include space to exclude certain specialists from the pooled referral option. Until these changes are introduced please list the specialists you wish excluded from the pooled option in the margin.
Note that the referral information is only sent to the specialist that will be seeing your patient.

Q - I want to clarify my choices. How can do I make additional comments to a form when there are only check boxes?
Future versions of the referral form will include space for physician comments. Health care providers are encouraged to also send a referral letter with the referral form. The new standardized referral forms are intended to capture a minimum set of relevant data to facilitate assigning the referral to the correct specialist. Referral letters, diagnostic imaging and lab results, etc. should be sent along with the referral form.

Q - Do some of the referrals go to a central intake and referral service?
Yes. To simplify the referral process for specialists who do not share an office, a central intake service was created. The Referral Management Services was developed within the Regina Qu'Appelle Health Region to support specialists that work out of separate offices but who still want to pool referrals. The Referral Management Services uses algorithms developed by the specialist group to determine the next available appropriate specialist able to see your patient. The service receives and redirects new patient referrals to the appropriate specialist's office, typically within 24 to 48 hours. The Referral Management Services does not triage or prioritize referrals.

The Referral Management Services has the skills and infrastructure to provide this service province-wide. The Referral Management Services employees are part of the Regina Qu'Appelle Health Region and protect patient confidentiality in the same way hospital records and operating room scheduling staff do.

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