Top 10 Things You Need to Know About a Referred Patient
Consider this advice to assure quality and efficiency.
By Sean McKinney, Contributing Editor

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With so many patients flooding retina practices today, practitioners need to establish protocols to manage cases efficiently while meeting quality standards. This article suggests approaches for referred patients.

Key items to cover
Below are 10 points to cover with a referral offered by Steven D. Schwartz, MD, Ahmanson Professor of Ophthalmology and Chief of the retina at UCLA's Jules Stein Eye Institute, and Pravin U. Dugel, MD, managing partner of Retinal Consultants of Arizona in Phoenix.

1. Establish the reason for the referral. "The first thing our staff is trained to find out is the urgency of the referral from the referring doctor, no matter who the doctor is," says Dr. Dugel.
   
   
2. Communicate with the referring physician. "Communicate with the referring doctor ASAP," says
   Dr. Schwartz. Dr. Dugel follows the directive of the referring doctor until more information is known. "It doesn't matter to me if the referring doctor is an optometrist, general internist, general ophthalmologist or retina specialist," Dr. Dugel says. "The referring doctor's direction determines if the patient needs to be seen immediately. We have an absolute rule in our office to see the patient as soon as the referring physician wants the patient to be seen. No questions asked and no exceptions."
   
   
3. Establish the chief complaint. "Determine the patient's perspective on the reason for referral," says Dr. Schwartz. Dr. Dugel's practice seeks a possible diagnosis when the referral is requested. "If the patient is diagnosed with a retinal detachment by the referring physician, a surgical scheduler will get immediate notification of a possible retinal detachment surgery that may need to be scheduled," says Dr. Dugel. "This way, the wheels are already turning."
   
   
4. Document medical and family histories. "The patient's current circumstances, medical history and medication use are critical," says Dr. Schwartz. "Patients with certain histories, such as a retinal detachment or filtering bleb procedure for glaucoma, are at special risk for complications that could threaten their vision," adds Dr. Dugel.
   
   
5. Gather demographic information. Demographic information can point to potential risk factors in a patient. In your documentation, include age, ethnicity and all relevant factors. "We want a full demographic picture of the patient," says Dr. Schwartz.
   
   
6. Investigate health insurance and social history. "We ask for insurance data, but also see many indigent patients and do a great deal of gratis work," says Dr. Dugel. Dr. Schwartz suggests identifying the patient's activities. "Does he work?" he asks. "Is he in a profession that requires binocularity? Is he retired?"
   
   
7. Find out if the patient's visual needs are being met. "If the patient is a child, disabled or has a language barrier, the patient may not be able to give you accurate or complete information," says
   Dr. Dugel. Dr. Schwartz agrees. "Establish the patient's current visual function, pre- and post-onset of the current issue," he adds.
   
   
8. Ask the patient what he hopes to accomplish. "Some patients just want an opinion. Some want treatment," says Dr. Schwartz.
   
   
9. Ask the patient if you have met his needs. "We like to take care of as much as possible while the patient is in our office," says Dr. Schwartz. "Efficiency improves care."
   
   
10. Follow-up with the referring doctor. "We always double back with a letter or follow-up phone call," says Dr. Schwartz. This ensures that the referring doctor knows what treatment his patient has received and why.

Properly trained staff
Drs. Schwartz and Dugel emphasize the importance of training your staff to work seamlessly on your approach to referred patients. "Ideally, all of the information is available to me before I meet the patient," says Dr. Schwartz. "Our team approach is the key to our success with referrals."