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Referral system at MIT Medical 'closes loop' in follow-up care

An idea by an MIT Medical nurse coordinator led to a departmental referral system that improves communication among clinicians, outside specialists, and patients.
OB/GYN nurse coordinator Nicole Napier M.S.M., B.S.N., R.N. came up with the referral-tracking system that became the model for MIT Medical’s new central referral office.
OB/GYN nurse coordinator Nicole Napier M.S.M., B.S.N., R.N. came up with the referral-tracking system that became the model for MIT Medical’s new central referral office.
Photo: Kateryna Odyntsova

As a patient, being referred to a clinician outside your regular medical practice is something of a leap into the unknown. You may not know how your primary care provider (PCP) will communicate with the outside clinician. If you’re being referred out for additional tests, you may wonder who will contact you with the results, or who will make recommendations for next steps.

What you may not realize is that referring clinicians often have questions, too. “We’d always wonder,” recalls OB/GYN nurse coordinator Nicole Napier, M.S.M., B.S.N., R.N. “‘Did the patient make the appointment? Did she keep the appointment? Will the specialist send us the report?’ Because we had no way of following up, patients sometimes fell through the cracks.

“I wasn’t in a position to do anything about it in my last job,” she continues. “But I swore that if I ever could, I would.”

Closing the loop

At MIT Medical, Napier got her chance. In 2007, she instituted a system in OB/GYN that used a paper trail to, as she put it, “close the loop” on every patient who was referred out. “I figured that if we had a piece of paper saying we referred someone somewhere, we could just hold onto it until we knew we had a report back,” she explains. Napier had her support staff remind patients to make appointments. And for appointments that had already been scheduled, she assigned one medical assistant to spend four hours a week following up. “She’d call outside providers — ‘Did the patient keep the appointment?’ ‘Where’s the report?’”

The system worked. “Before we started doing things this way,” Napier says, “we were always looking for reports that hadn’t come back from outside clinicians. But by devoting just a few hours a week to follow-up, we were able to close out almost 100 percent of our referrals.”

Improving the process for everyone

Meanwhile, Ruth Fishbein, MIT Medical’s director of performance improvement and risk management, had convened a team of clinicians, administrators, front-desk staff, and information-systems people to come up with ways to improve the referral process for MIT Medical as a whole. “Patients usually scheduled outside appointments at cluster desks, which was a privacy concern.” she explains. “We wanted to find a better way to help patients make and keep appointments. And we wanted to develop a system to assure that providers received reports from outside specialists.”

“Fortunately, we didn’t have to reinvent the wheel,” says Phyllis Winn, an administrative coordinator at MIT Medical and member of the Referral Process Improvement Team. “We just had to figure out how to duplicate on a larger scale what Nicole was already doing for 150 monthly OB/GYN referrals.”

The result was a centralized referral office that opened in late 2010 and currently serves all clinical areas of MIT Medical except Mental Health and Counseling and OB/GYN, where Napier continues to use the referral system on which the new office was modeled. “Now patients don’t have to talk about their health concerns in close proximity to waiting areas, Winn says. “They can come into the referral office and speak one-on-one with a referral representative.”

Through MIT Medical’s electronic medical record software, MIT Medical’s three referral representatives are alerted every time an MIT Medical clinician makes a referral, and they follow up on each one. “With the old system,” Fishbein explains, “patients either kept their outside appointments, or they didn’t. Clinicians either received reports, or they didn’t. Now we have staff whose job it is to track and process about 1,700 referrals a month.”

Better patient care

But it’s not just the numbers that tell team members the new system is working; they’re also hearing from patients. In an email last winter, one patient wrote, “I am very happy with the referral system at MIT Medical. My PCP recommended that I get a test at Mount Auburn Hospital. MIT Medical’s referral office called and gave me the information I needed to make the appointment. On the day of the appointment, it was snowing, so I cancelled. Within the week, someone from the referral office called to remind me to reschedule. I was stunned that someone cared about me like that! I rescheduled my appointment, and everything was fine. I really appreciated the follow-up from MIT Medical.”

For Fishbein, Winn and others on the team, it’s all about improving patient care. “This new system allows us to coordinate better with outside specialists,” Winn says. “And care that is better coordinated is better care.”

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