Practical Matters: Setting the stage for successful referrals

It is a big decision for both you and your client to refer your patient to a university or other specialty practice for further workup or tertiary care. To set the stage for a positive experience, take steps to ensure optimal communication between you, your client, and the referral institution.

One common communication pitfall occurs when referring veterinarians send photocopies or facsimiles of patients' medical records instead of referral letters. Most universities and specialty practices have referral forms that can help you provide the most relevant patient information. These forms can often be found on the referral hospital's Web site. If a form isn't available, compose a concise case summary, including the patient's history, physical examination results, abnormal diagnostic test results, and your diagnosis or differential diagnoses. Also summarize your case management, including the drugs and fluids administered and the patient's response to therapy. Provide copies of laboratory results and radiographs. Offering insight about your expectations for patient management (e.g. further diagnostic tests, surgery) is also important.

Another step in ensuring successful referrals is to prepare clients for their referral appointments. Ideally, your office should set up the appointments and tell your clients the names of the clinicians who will be seeing their pets. In addition, your clients will appreciate it if your office prints directions to the referral clinic or directs them to the referral clinic's Web site. And if possible, tell your clients what to expect regarding the anticipated duration of their pets' hospitalization, and give them a general idea of the expenses involved with the referral and the financial expectations of the referral practice.

If problems occur in a referral, it is best to address them in a timely manner, as it may be difficult for the institution to effectively address a problem weeks or months after the fact. Contact the clinician who managed the case and outline your concerns. If the problem remains unresolved, speak to the senior clinician. The next steps include contacting the practice manager or the clinical department head and, finally, the hospital director or dean. A formal letter outlining your concerns has a higher likelihood of eliciting a satisfactory response than does a phone call.

Both universities and specialty practices depend on practitioners for a constant flow of referral patients. And the marketing benefits of referring (e.g. the availability of state-of-the-art equipment and a specialist managing difficult cases) are advantageous to your practice, especially with clients' heightened understanding of the evolving complexity of healthcare.

Everyone's goal is to provide patients with the best care possible. A successful referral includes a patient with a resolved medical or surgical condition, a positive relationship between the general practitioner and the specialty institution, and an informed and satisfied client who will return to the referring veterinarian for continued care and follow-up. Good communication is the key to making all this possible.

Stan Rubin, DVM, MS, DACVIM (small animal internal medicine)

Veterinary Teaching Hospital

Western College of Veterinary Medicine

University of Saskatchewan

Saskatoon, SK, Canada S7N 5B4

Stan Rubin, DVM, MS, DACVIM (small animal internal medicine)