[BubbleRN]

I'm wondering who takes referrals in your offices. Two other agencies I worked for had RN's taking referrals. Now, the secretaries do! Needless to say the information is often incomplete and we fear something coming back to haunt us. Is this legal? Are there requirements in the referral chain? I would love to know where to find rules that agencies should operate under and abide by, I just don't feel that things are kosher here.

[NRSKarenRN]

There are no regulations regarding who takes referral information. If clerical staff only are used to obtain referral information, the admitting RN is the person who discusses patient care needs + initial orders with the physician and develops plan of care for homecare services. It is up to each agency to have a policy regarding referral/admission acceptance. Does your policy reflect agency practice????

Having been in homecare 20 + years, I now manage a Central Intake department that processes 1,600 referrals monthly. The lack of information coming out of facilities has declined in quality significantly over the last 2 years. I have both RN's and clerical staff to obtain and process referrals. Detailed synopsis of hospitalization/inpatient facility stay is almost nonexistent as facilities are using RN's as case mangers with insurance companies to get hospital auths and social workers are increasingly responsible for 'giving referrals": reading off demographic sheet information, services requested and giving auth numbers for managed care clients.

Can't tell you the number of times given what appears to be complete info and before hanging up ask "is there anything else I need to know?" told "oh yes, needs wound care" WHAT wound, where located, treatment orders....none of the diagnosis: Ambulatory dysfunction, HTN, Pneumonia indicated a wound!! "Check the discharge orders, the charts not available"
GRrrrrrrrrrrrrrr. In the office today and referral source called as dtr hysterical that no one called to set up visit to teach her how to give Dad's insulin. My staff pulled referral from yesterday faxed from hospital; DX: Pneumonia PMHX: NIDDM----off to side scribbling deciphered "teach glucometer use". Staff told 2 day window ok. NO mention re new Insulin Dependent diabetes. We're not mind readers. So I can empathize with you.

The completeness of information that one receives from the intake staff significantly impacts on field staff's ability to perform admission visit.
Due to shear volume, I've started using clerks in the past year to supplement RN staff. Education of clerks is most important to gather the right information based on diagnosis/care needs. I developed outline of questions to ask based on stated diagnosis: wounds, labs, injections, foley care, catheter management, oxygen needs etc. Clerks then sit with RN staff for 2 -3 days to learn referral processing, then spend 2-3 days taking referrals with RN's at their side. Each clerk is paired with RN preceptor who reviews all referrals taken prior being processed until clerk ready to go on their own with RN overhearing their conversations. I also sit with them for several hours over first couple of weeks. Any referrals involving medications, they will start demographic and insurance info then turn over to RN.

Best way to approach your concerns regarding referrals is to talk with your Quality Assurance staff. Document instances re lack of information and impact it has had on patient care: # patients with wounds and no wound supplies, tube feeding patients without equipment, # times came back to office for pulse oximeter/coag machine/glucometer, etc.

Hope that I've given you some ideas so you can get your concerns addressed.

[cookie102]

wow!!! where do you work ? 1600 referral/month, must be a huge agency, just curious

[DutchgirlRN]

Where I work only RN's can take referrals. It's not that the clerical staff is not capable, it was a decision by the CEO and strictly enforced. They compare it to only a nurse can take a doctor's order over the phone. Our clerical staff is relieved they don't take referrals. We have an average of 500 admits per month. 1600 Wow!!

[at your cervix]

In our agency the RN takes the referrals whenever possible. In the situations where an RN is not available, the office staff will take basic info (patient's name, MD's name, hospital being dc'd from etc) and then they have a list of info to ask to be faxed to us-Face sheet with demographic info, orders, H&P, med list and discharge summary if available. The RN then reviews this info before going out to see the patient and will call for clarification if everything is not on the orders. There are alot of times that the facility will not even call us, they will just fax over a one page order with nothing but the patient's name and an order that simply says "home health" and then of course they act totally put out when you call to ask for info such as...oh, I don't know maybe the pt's diagnosis or, possibly their ADDRESS or PHONE NUMBER!