Get ready
Before you start
Pick one referral type and include the staff who actually handle it. Describe roles, channels, and handoffs without copying patient details into this checklist. Keep patient-level work inside the practice’s approved systems.
Map how a request starts
- Where do requests arrive: the EHR, phone, portal, fax, or front desk?
- Who checks the request for missing information, and who obtains the clinician’s order or signature?
- How does staff distinguish an insurance-required referral from a receiving office’s requirements?
What to capture
List the entry points, the responsible staff role, and the existing place where the request is recorded.
Follow the handoff to the specialist
- Who confirms the receiving office and the information it needs?
- How are records sent through an approved channel, and how is receipt confirmed?
- Where does staff record missing information or a request returned by the receiving office?
What to capture
Identify the handoff owner and what counts as confirmation that the receiving office has the request.
Understand scheduling and access
- Does the patient or caregiver, referring practice, or specialist office arrange the appointment?
- How does the practice learn that an appointment was scheduled, canceled, or could not be arranged?
- Who handles administrative barriers, and how are clinical concerns routed under the practice’s existing policy?
What to capture
Write down who owns each follow-up and where unresolved scheduling work is visible to that person.
Trace the specialist report back
- Where does the specialist’s report arrive, and who matches it to the original referral?
- Who follows up when the report has not arrived according to the practice’s process?
- How is the report routed for clinician review, and where is that review documented?
What to capture
Keep “sent,” “scheduled,” “report received,” and “reviewed” distinct when describing the workflow.
Choose one problem worth testing
- Which repeated interruption or handoff creates the most avoidable staff work?
- Could an existing EHR feature, clearer responsibility, or staff training address it?
- What small change could the practice approve, and what result would show that it helped?
What to capture
Choose one referral type, one problem, one responsible person, and one measure before considering a new tool.
Bring it together
Leave with a simple baseline
For a defined period, consider aggregate counts of incomplete requests, scheduling barriers, missing reports, or staff minutes spent resolving exceptions. Define each measure with the team first. These are possible measures, not performance targets or evidence that every practice has the same problem.
The useful outcome is a clear statement: “For this referral type, this handoff causes this recurring burden, and this person will test this change.” If the workflow already works well, record that too.
Further reading and scope
For a broader patient-safety framework, see the Institute for Healthcare Improvement’s Closing the Loop: A Guide to Safer Ambulatory Referrals in the EHR Era. It describes a nine-step process that extends through review, communication, and follow-up.
This is Referral Desk’s administrative discussion checklist, not a validated clinical protocol or an IHI-endorsed tool. Clinicians and practice leadership set clinical priorities and escalation rules. Referral coordination is our starting point as we learn about independent practices and their wider needs.