Building a Better Program: Engaging Your Referral Network

The hospitalist movement in the mid-1990s was met with excitement and trepidation. Many detractors of the hospitalist concept were concerned with the effects it would have on continuity of care, predicting that when patients got admitted into the hospital with an acute problem there would be a “voltage drop” of information across the hospital threshold. In other words, they were

concerned that patient care would be fragmented, which can lead to poor clinical outcomes, redundancy of testing, and unexpected readmissions, all of which ultimately increase medical costs.

When a hospitalist practice has difficulty ensuring continuity of care, its leaders (both administrative and clinical) should investigate the root cause. Perhaps this difficulty is due to an understaffed program and/or an inefficient scheduling model that places unreasonable time constraints on the hospitalist. The “voltage drop” may be a consequence of ineffective communication systems and processes. It may also be a reflection of provider attitudes. Whatever the reason, there are many tools and strategies for promoting continuity of care available to hospitalist programs.

Every strategy that furthers continuity of care begins with effective communication. Hospitalists have a variety of tools they can use to provide patient updates to referring providers, including secure e-mail or fax , a shared EMR, and even telephone and voicemail. Communication between the hospitalist and referring provider should occur upon patient admission into the hospital, after major changes in the patient’s condition, and upon discharge.

Hospitalist programs should communicate with their referral networks for reasons beyond direct patient care. Visits by program leaders to the offices of referring providers can help to improve communication among all parties, support collegial relationships, educate office staff, and serve as a forum to discuss both the hospitalist’s and referring provider’s clinical responsibilities. The program’s informational brochures can also be delivered during visits. For continuity purposes, it’s a good idea to assign a specific individual to each outpatient practice.

Hospitalist programs can also engage their referral network by sending out newsletters that provide updates about new program policies, procedures, and protocols and introduce new hospitalist providers. Another way to foster collegiality and collaboration is to arrange get-togethers and other social events.

Developing a user’s group is another strategy that supports communication between the hospitalist practice and referral network. The participants may include hospitalist providers, PCPs, specialists, emergency department providers, and hospital administrators.

This strategy provides a forum for discussing clinical, operational, and/or administrative concerns related to the program and engages the outpatient physicians and maintains their involvement with the hospital. The user’s group can serve as a sounding board for new policies and protocols and promote discussion of controversial changes to the program. Participants who have had the opportunity to voice their opinion and provide input are more likely to support new policies and champion the initiative among their colleagues.

Distributing a satisfaction survey is another way to engage the referral network and provides these physicians with a vehicle to offer feedback. It also provides the hospitalist program with valuable information in order to assess performance. Hospitalist programs should also solicit the participation of key referring physicians during the recruitment process. Not only will this provide the referral network with a voice in selecting new hospitalists, it will also send the candidate a message that the referral network supports the hospitalist program.

There are many reasons why your hospitalist program should engage its referral network. Mindful engagement will support both continuity of care and successful clinical outcomes and may help to drive down the cost across an episode of care. Avoiding unexpected readmissions can save your institution hundreds of thousands (and perhaps millions) of dollars, money that can be in-vested in the development of operational and clinical systems that support both quality and efficient medical care. Engaging your referral network will also promote customer satisfaction, collegiality, and collaboration.

Ken Simone, DO, FHM, is a board-certified family physician and the founder and president of Hospitalist and Practice Solutions, a consulting company that develops, restructures, and redesigns hospitalist programs.