Appalling lack of response for referrals

Thank you to Dr Neimanis et al¹ for their article on referrals and wait times. I was appalled by the statistic that 36.4% of requests for consultation did not even receive a response.

I am Medical Director for a hospice and community palliative care outreach program. We receive well more than 100 referrals every month. It is not uncommon to receive 10 or more in a single day. These referrals come from FPs, nurse practitioners (NPs), and specialists like oncologists, respirologists, and cardiologists, just to name a few. We follow the September 2019 “Transitions in Care” policy from the College of Physicians and Surgeons of Ontario:

• 17. Consultant physicians must acknowledge referrals in a timely manner, urgently if necessary, but no later than 14 days from the date of receipt.

• 18. When acknowledging the referral, consultant physicians must indicate to the referring health-care provider whether or not they are able to accept the referral.

  1. a. If they are, consultant physicians must provide an anticipated wait time or an appointment date and time to the referring health-care provider. When providing an anticipated wait time, consultant physicians must follow-up once an appointment has been set.

  2. b. If they are not, consultant physicians must communicate their reasons for declining the referral to the referring health-care provider.²

Most often our response is a consultation letter to the referring physician or NP, as our wait time for new consults is less than 5 days (total days, not business days). We offer same- or next-day consultations when contacted directly by a referring physician or NP. Our wait time is kept low through a combination of real-time triaging and centralized intake that distributes new referrals quickly and appropriately. We follow up with all declined referrals in writing and with a telephone call to the referring provider with a suggestion on how best to redirect their request. As both a focused-practice family physician and a specialist, I would encourage all physicians who receive consultation requests to review their process for receiving referrals and show respect to our colleagues in primary care and, more importantly, patients. While many specialists can and do respond in a timely fashion, my hope is that a one-third nonresponse rate as indicated in this study is an anomaly.

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