IHI.org - A resource from the Institute for Healthcare Improvement
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Decision Support:
Establish Linkages with Key Specialists
    1. Find specialists who will treat your patients and support your improvement efforts.
    2. Review guidelines with specialists to get their input and buy-in.
    3. Work with specialists to define appropriate patients for referral, based on the guidelines.
    4. Work with specialists to clarify the approach to follow-up (i.e., the process for getting information to the primary care provider after the specialist sees the patient).
    5. Develop a mechanism to track the following:
      • Referral made
      • Specialist saw patient
      • Specialist's letter received by primary care provider
      • Patient returned to primary care provider
    6. Use joint visits with specialists or direct phone consultation and other innovative primary care/specialist relationships.

Tips
  • Seek out institutions with a smaller public health mission or teaching institutions to identify specialists to work with.  Teaching hospitals may agree to have residents or fellows (cardiology, optometry, podiatry, dental, etc.) rotate through your practice who then can help link to hospital for needed procedures.
  • Ask specialists to be part of the team.
  • Include specialists in the guideline development process.
  • Streamline the process for communication back and forth (e.g., fax-back forms, e-mail, telephone conferences, telemedicine sites).  The easier it is the more likely it will happen.
  • Use the same specialists whenever possible.
  • Have senior leadership make follow-up between specialty and primary care provider a clear expectation at both locations.
  • Designate a specific person to do the tracking and develop a standardized process to track referrals and information from the specialist.  If possible use a registry to track this information.  Audit 5 to 6 patients periodically to see if this process is working.