CMs smooth path for referrals to specialty clinic

Patients referred to care in most appropriate setting

When patients at a busy emergency department (ED) are referred to a clinic for specialty care, they may fall through the cracks if no one follows up.

That’s where Christine Ruschmeyer, RN, BSN, adult ED case manager at Jackson Health System in Miami comes in.

Ruschmeyer follows ED patients who are referred to one of the hospital’s numerous specialty clinics by ED physicians who see more than 90,000 patients a year. Her job is to make sure that all patients get the care they need in the setting that best fits their needs.

"I make sure that I get a copy of the consults the emergency room doctors make to the specialty clinic and make sure the patients get an appointment in the most appropriate place," she adds.

For instance, if patients are covered by an HMO or other private health insurance plan, they can’t see the specialty clinic without prior authorization.

In other cases, a patient may not need to go to a specialty clinic but can receive care from a primary care physician at one of the hospital’s community clinics.

Each specialty clinic has its own criteria for the types of patients it will see. For instance, a patient with a new diagnosis of diabetes doesn’t necessarily need to be seen at the endocrinology clinic.

A patient with Bell’s palsy often can be treated by a primary care physician rather than a neurologist.

Before Ruschmeyer began tracking the patients, they might show up for a specialty clinic and be turned away because they didn’t meet the criteria for specialty care or because the specialty clinic didn’t have enough information.

Because the ED physicians are busy, the consults may have sketchy information. For instance, when a patient comes in with a migraine headache and the physician orders a neurological consult, the physician may just write "headache" on the form. The neurological clinic is likely to refuse to see the patient because there’s not enough information.

Ruschmeyer collects all the consults, looks at the chart, and adds patient history, information from the labs, and other pertinent data so the clinic will have as full a picture as possible. Instead of faxing the referrals or sending them in intraoffice mail, Ruschmeyer delivers them in person and presents them to the attending physician.

The specialty clinics meet only half a day, one day a week. Ruschmeyer waits until that clinic is in session to present the consult and set up an appointment.

The specialty clinics automatically mail appointments to the patients. If time is of the essence, she contacts the patients herself to let them know about their appointment.

All patients who are referred to specialty clinics get a letter telling them they may or may not be accepted for specialty care, depending on whether they meet clinic criteria and urging them to seek follow-up care in the meantime with a primary care physician or clinic.