Health Information Technologies and Processes

REFERRAL DOCUMENTATION FOR PATIENTS THAT NEVER SHOW

  • 1.  REFERRAL DOCUMENTATION FOR PATIENTS THAT NEVER SHOW

    Posted 14 days ago
    We have a wound care clinic at our hospital.  They often get referrals from outside doctors offices for patients needing wound care.  For whatever reason, the patient ends up not getting services in our facility.  However, there is paperwork, including referral, office notes, insurance information and handwritten notes by wound care staff indicating phone calls, reasons for no show etc...

    The patients do not have any related accounts to scan this documentation in. My question for my peers, is do you keep it?  If so where?  Or do you shred it?  Thanks for your input.

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    Stacey Goodenough
    Manager of Medical Records / Privacy Officer
    Wayne Memorial Hospital
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  • 2.  RE: REFERRAL DOCUMENTATION FOR PATIENTS THAT NEVER SHOW

    Posted 14 days ago
    HI Stacey,

    I recommend checking with your professional liability carrier regarding their expectations and recommendations, since missed/incomplete care can obviously result in missing care and potential medical liability, especially if the care was 'urgent'.  (You have no way of knowing what the patient said to the referring provider unless that is checked, nor any way of knowing if the referred patient missed the appointment due to currently being in 'medical crisis' without follow-up.)  The risk management policies I have reviewed and liability companies I have worked with usually recommend keeping track of no-shows, making multiple attempts (documented) to contact the patient, and they stress importance of also notifying the referring provider to 'close the loop' and of maintaining positive referring provider relations.  State laws may have an impact on this.

    Below is an example of a medical liability company's recommendations:
    https://www.medicalmutual.com/risk/practice-tips/tip/appointments-referral-not-completed-missed-no-show-amp-canceled-appointments/36

    The IHI has a downloadable guide that covers how to close the loop on referrals, including no-shows, because it is important to keep track of these, especially when there is no reason given, even if you don't retain all of the collected information, so that providers demonstrate they did receive the referral, made reasonable efforts to notify the patient and referring provider of missed appointments by 'closing the loop', and insulating the provider/organization from any potential liability.  You can terminate the no-show patient relationship from the practice if this a repeating occurrence, which should ideally also be part of documented policies.

    IHI --> http://www.ihi.org/resources/Pages/Publications/Closing-the-Loop-A-Guide-to-Safer-Ambulatory-Referrals.aspx  (login required, but free to register for access).

    Once you have completed 'closing the loop', you should be able to follow your organization's policy for destruction of medical records (which should include referrals for no-shows), once your risk management department / practice counsel and liability provider are satisfied that any obligations for contact and follow-up are completed -- but retain proof the of no-shows and proof (log) of the destroyed medical records, which you may want to keep separate from patients who were seen.

    Hope this helps!

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    A. Andrews Dean, CPHIMS, CHPS, CHDA, CPPM, CPC
    Health IT Regulatory Affairs & Healthcare Compliance Consultant
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