Can Improved Communication Help the Referral Process?

Patients, coordinators, transplant teams, and outside organizations, transplant centers are in a constant funnel of communication.  

This communication process tends to be unidirectional and without communication feedback which is critical to successful outcomes.  


This results in costly delays throughout the referral process including incorrect, redundant, or misdirected information. Further, when team members cannot effectively relay information, the resulting incorrect or piecemeal communication can lead to harm to patients. In fact, over 500 reported sentinel events occurred over the last five years as a result of poor communication. 

Why current communication processes don’t work for patient referrals

The status quo isn’t working. Patient referrals stall because no one knows who is supposed to take the next step or where the patient is in the referral process. This has to change if we are going to help patients get the care they need. 

Too much busy work and lost information

Dialysis and medical teams refer a patient to transplant, but they may not send all the information the transplant coordinator needs. Coordinators, on the other hand, may not know what information they are missing and be unaware they need to ask for additional information.

Referrals may get lost in the complex web of disparate EMRs and siloed tech stacks. If the EMRs don’t talk to each other, one team may have the most up-to-date patient information, but that info doesn’t get shared with the other teams.

With incorrect or outdated information, transplant and dialysis staff get stuck in extra busywork of faxing, scanning, and combing through complicated email threads and phone calls in order to keep each other informed. This administrative busywork takes the team’s time and slows down the referral process.

No streamlined referral process.

Another problem in the referral process? Everyone is waiting for someone else to take action because there isn’t a standardized process that’s mutually agreed on by both dialysis and transplant teams. Transplant may be relying on their dialysis care team to handle next steps while dialysis expects transplant to take the next action. Meanwhile the patient is stuck in the middle, waiting for someone to call them to set up an appointment.

The bottom line: without a standardized referral process, everyone is waiting for someone else to take the next step, but no one knows what that next step is.

What is the solution?

CMS calls for dialysis and transplant centers to incorporate bidirectional communication in their referral process. In March 2019 they updated their interpretive guidelines: “Transplant programs must have bidirectional communication with the dialysis facility about any waiting list status changes or changes in patient condition.”

However, how to do this is less clear. Most centers use traditional, unidirectional communication forms like email, fax, texts and phone calls. To make these communication methods “bidirectional” they go through a complex process of faxing patient information to other parties and scanning to the EMR while the other party goes through a similar process of their own.

That combination of faxing, scanning, and emailing is not truly bidirectional and leaves too much room for human error. While it may technically meet the requirements, it does nothing to help patients get quality care faster. Additionally, it bogs down the team and is costly in time and money both to the transplant centers and to medical and dialysis referrers.

How does this help?

True bidirectional communication allows two parties to efficiently communicate and acknowledge messages sent and received. Having an open line of communication that also automatically documents the conversation is also key to reducing redundant and unnecessary work. 

When transplant teams close the loop in their communication, they know both the sender and receiver receive the correct messages. This leaves little space for communication breakdowns in the referral process.

What would this look like for referral management communication?

Everyone stays updated

A standardized process would keep each member of the team updated on the patient’s treatment and waiting list status so that all parties would know where the patient is in the referral process and what the next step is.

No missing information

This standardized process would also notify the referring dialysis facility of any missing or required information. With a referral checklist in place, teams would have everything they needed before seeing the patient.

Speed up the patient referral process 

With the updated CMS guidelines and the executive kidney health initiative, more patient referrals are coming. The current communication processes aren’t equipping transplant centers to handle this increase in volumes. By standardizing the process and using automation where possible, dialysis and transplant teams will be able to move patients through the referral process quickly to get them the care they need.

Learn more by reading  "Why Transplant Centers Get Stuck in a Communication Cluster."

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