Patient referrals from a hospital nurse and referral coordinator perspective

Many times we come across some challenges in our organization’s health care system and we wish there was a better way to manage patient data.  Our healthcare system is constantly changing to improve the quality of patient care, reduce overall costs and medical errors, and make it more efficient to use for the end user.

Old fashion pen and paper is going away and we are slowly transitioning to more advanced electronic medical records.

Introductions: Lucine Kenderjian – Registered Nurse

Referral management for hospitals | hospital referral marketingI’ve been a registered nurse for over 9 years now working at different hospitals; I can tell you that health care has definitely been progressing. We are still going through changes every day to improve our systems to make it more efficient and safe for patients and staff. We use an electronic medical record software, called Meditech at Children’s Hospital of Central California for couple of years now and we have added and deleted programs to make it more useful and effective.

Change is sometimes hard for those who are used to doing things the same way. It’s scary and frustrating but eventually we all get used to it and learn to adapt We are constantly modifying Meditech but we are still having challenges about how we process the referrals. We don’t have a system in place to track our referrals and many times our patients get readmitted to the hospital because of missed appointments or the doctor’s office didn’t call them back or they don’t have a PMD. We bin our referrals in the Meditech system hoping the patients will get notified when the appointments are made but a lot of times they don’t get followed through to the referring doctor so it delays patient care, increases hospital stay time, and in return increases cost. For non-profit hospitals, these delays can mean not being reimbursed, so we end up helping the patient for free.

I spent a few hours at one of our clinics with the referral coordinator Martha, a designated staff who exchanges referrals on a daily basis. I could see her frustration when she voiced her concerns about the process. Even though we transitioned to EMR, we are still doing referrals on paper faxing. Her day consisted of hours and hours of going back and forth to the fax machine, follow up phone calls to make sure the fax got through, making appointments, faxing forms, calling the doctors back to verify missing information, waiting for a call back from a referring doctor, sifting through piles of papers, organizing them, filing them for eight hours a day every day is exhausting and prone to errors.

During our interview with Martha, she said she wished she had more time doing other things like helping patients more; maybe her job wouldn’t be so repetitive and frustrating.

There has got to be a better way, we thought. What about the patient confidentiality? What if the fax went to someone else with private patient information, HIPPA rules? Delaying patient treatment; amount of dollars spent mismanaging the referrals could be used to pay the staff higher salaries or lower patient health costs? and what about the patients’ health?

The current paper based process is not cost effective, safe, or easy for our staff to manage.  These are the questions that are going through my mind.


Personal family experience with paper referrals forms 

I’ve had experiences with taking my family members to a doctor’s appointments where we had to wait several weeks to get an appointment with a referring doctor. The primary physician referred my grandmother to three different specialists before they schedule her for a surgery. After several visits to different doctors’ offices, I still had to make multiple phone calls to follow up with each doctor to make sure they sent her records back to the surgeon so they can schedule her surgery.

The communication between them is broken, they had lost her files. When I called the surgeon’s office to find out about the status, the nurse told me we are still waiting for them to fax the test results before we can proceed. I called back the urology clinic and I got a different answer. We were told that she needed another appointment for one more test that was scheduled from the previous appointment but didn’t get done and they didn’t have any appointments for three more weeks unless they get a cancellation. I was very upset.

My grandmother has been very anxious to get this surgery done ASAP because she couldn’t tolerate the pain anymore and now we find out it’s going to be delayed even longer. As a nurse, I felt helpless and frustrated with the system but yet I couldn’t do anything about it except to keep calling and follow up with a doctors to make sure things were getting done. If there was a system available in place for referrals where all these can be done electronically then patients will get better care, doctors’ offices will be able to communicate better and operate more efficiently. 200,000 patients die every year in the United States due to inaccurate or latent referrals.

Most of the healthcare practitioners in the United States are still using the antiquated fax machine and triplicate forms to transmit referrals.  We need to raise awareness of newer technologies such as ReferralMD, to make it better for patients and the staff that manages the referral process.


Lucine Kenderjian
Registered Nurse
Children’s Hospital of Central California


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