Lesson Plan – Making a Referral

Read this blog post from RCEM Learning.

Listen to this St Emlyn’s podcast with Simon and Iain, which will reenforce the learning from the RCEM article. If you have time also read this blog post

This part of the teaching session should be lead by an experienced clinician. The priority in this task is to put together succint referrals and practice delivering them to a colleague.

During the discussion you may want to talk about particular quirks in your hospital system that are particulary relevant.

In this session we have learned about how to refer patients to speciality colleagues. Remember these top tips:

• 1, Never, ever lie or try to “sell” a patient. If you feel you have to do this ask yourself does the patient really need to be admitted or is there something else you could be doing in the ED? Also, word soon gets round if you are not telling the truth about patients and that important trust between you and the inpatient team is lost.
• 2, Practice your referral in your head – Does it make sense? Is the reasoning clear? Are there any questions you might be asked that you cannot answer?
• 3, Introduce yourself with your name, not just your designation and try to refer to the inpatient specialist by their name. By personalising the process it is much harder for someone to be rude to you and dismiss your request.
• 4, You are referring the patient. Very, very rarely will you be “asking for advice”. Your expected outcome is admission not further work up in the ED/CDU.
• 5, Try to get to know the inpatient teams (see 2 above) and show an interest in your patient’s outcome. Try to call them later in the shift to find out how your patient did – not only does they help your learning, but shows the in patient specialist that you were interested in your patient having the best and most appropriate care, not just how you could shift them from the ED and forget about them
• 6, Remember that colleagues can be very busy. You may have just interrupted their lunch – no wonder they can get grumpy. Try and be understanding whilst being assertive.
• 7, Finish your referral with your voice going down in pitch – suggesting the end of the conversation, rather than rising – suggesting you are asking a question and opening up an unwanted viva opportunity.
• 8, Show “Grace Under Pressure”. Never, ever get into an argument about a patient – as soon as you raise your voice you have lost the moral high ground. If you are having real trouble inform the inpatient specialist (politely) that you are going to talk to your Consultant/Registrar to confirm the referral was appropriate and that you will call them back

Finally, it’s probably fair to say that making referrals is a skill. Just like all things in medicine it is something that you will need to practice and reflect on.

In order to embed today’s learning further, reflect on what you have learnt and record in your portfolio whether it has had any impact (or is expected to have any impact) on your performance and practice.

Will this change how you approach your next referral?

Discuss this session with your colleagues – were there people who missed it who you can share the highlights with? Can you practice referrals together?