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Improve referral case management


Smooth over communication wrinkles when you refer to specialists, and provide better case management for your patients.

Ensuring smooth communication among your teammembers is a challenge. Now add in communicatingwith the team at a teaching or specialty hospital,and you’ve got your hands overflowing-or at leastthat’s how it feels. Yet smooth communication betweenreferring practitioners and specialty clinicians is absolutelyimperative. And the absence of it is the biggest problemplaguing those relationships, says Dr. Stan Rubin, MS, Dipl.ACVIM. “Miscommunication can lead to differences inexpectations-and that causes problems,” he says.

Dr. Rubin has worked 22 years at the Veterinary TeachingHospital at Western College of Veterinary Medicine,University of Saskatchewan in Saskatoon, Saskatchewan.He says wires commonly get crossed over time and money.“A referring veterinarian might tell an owner how muchit’s going to cost when in fact he or she has seriously underestimatedthings,” says Dr. Rubin. “It’s better to tell theclient you don’t know how much the treatment will cost.”

A similar misunderstanding happens with time. “Say apatient is referred for lameness,” he says, “and the clientgoes through a great deal of time and trouble to get to theteaching hospital only to discover that the animal does needsurgery but the hospital can’t do if for two or three weeks.”

Dr. Rubin says the ideal is for the referring veterinarianto actually talk to the specialty clinician or referral coordinatorabout the case. “That’s really the only way to get agood idea of prices and what’s going on,” he says.

The smooth transfer of information

One of the best ways to improve communication overall, Dr.Rubin says, is to use a referral form. Many universities andspecialty practices have referral forms. If they don’t, use theone posted at vetecon.com as a starting point. Include thepatient’s history, physical exam results, abnormal diagnostictest results, and your diagnosis or differential diagnoses.Also summarize your case management, including drugsand fluids administered and the patient’s response to therapy.Provide copies of laboratory results and radiographsand offer any insights about your expectations of patientmanagement, such as further diagnostic tests or surgery.

In an ideal world, you’d fill out such a form every timeyou refer a patient, says Dr. Rubin. But he knows that withlimited time and resources, sometimes this important stepgets skipped-especially when the case is urgent. At thevery least, he recommends you send a cover letter thatsummarizes the case and the direction you think it needsto go. “The more urgent a referral, the more important thisinformation becomes,” he says. “And, there’s a biggerchance for miscommunication without it.”

Even sending just photocopies of the animal’s recordisn’t as effective as providing a form with the exact informationrelevant to the case at hand, Dr. Rubin says. “Somebodyhas to go through a sometimes lengthy record page bypage to gain insight into the case. It’s so much more effectiveto receive a summary and copies of lab work.”

Miscommunication is the biggest problem between referring general practitioners and specialists, Dr. Stan Rubin says. Use a referral formlike the one posted at vetecon.com to help improve patient care.


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