What makes a clinician-friendly medical referral form? An engineer publishes tested recommendations to close the communication loop.

You’ve likely heard the advice before: Provide user-friendly consultation order forms to your referring providers. Be sure the referral forms promote the transmittal of clear, complete, and correct data to your sleep or dental sleep practice.

But what exactly makes for a clinician-friendly referral template? Recommendations have been published before, but recently a human factors engineer went a step further. April Savoy, PhD, a research scientist with the VA Center for Health Information and Communication at the Richard L. Roudebush Veterans Affairs Medical Center, and colleagues implemented several recommendations into a scenario-based simulation experiment. They tested a control electronic referral form and their recommendation-incorporating prototyped form with primary care clinicians who were referring patients to a variety of specialists.

Some of the communication problems that Savoy’s team hoped to resolve included unclear goals in referral, specialists rejecting a consultation pending more information, missing details that needed to be provided by the patient, and phone tag between busy professionals. The researchers found that implementing a few recommendations from the referral communication literature significantly improved clinicians’ satisfaction, workload, and efficiency. You could implement several of the successful features immediately into your own referral templates.

Include a checklist of “urgency” options. The prototype form allowed for “routine (30 days),” “stat,” or “specific time,” as well as a free-text field for comments. “Referrers, who are most familiar with their patients’ typical health, are best equipped to gauge urgency, not consultants or schedulers,” the authors note.

Remind referring providers of your expectations at a glance. Include an “About Us” section with a few bullet points, such as “Individuals with sleep irregularities manifested by daytime sleepiness, snoring, witnessed apneas, morning headaches, insomnia, or abnormal nocturnal movements or behaviors would benefit from a sleep evaluation.” Bulleted information on how to avoid cancelled consults is also appreciated. For example, a dental sleep medicine practice may want to include verbiage such as, “Interpreted sleep study results, from a home or in-lab study done in the past 12 months, must be attached.”

Allow free space for additional comments. The researchers note that this feature employs the human factors design principles of “flexibility and efficiency” and “users in control,” among others.

Provide multiple ways to contact you. “Failure of the primary care doctor’s office to request the appointment, or failure of the specialist’s office to address the request for a consultation, can be caused by something as basic as a message buried in an inbox, or a failure to confirm availability with the patient,” says senior author Michael Weiner, MD, MPH, director and research scientist at William M. Tierney Center for Health Services Research, Regenstrief Institute Inc.

Get more tested recommendations by reading the published paper, “Comparative usability evaluation of consultation order templates in a simulated primary care environment,” available with a ScienceDirect subscription or for individual purchase. There is currently no packaged electronic referral template but Savoy says she is happy to discuss specific needs with clinicians or researchers (april.savoy[at]va.gov).

Sree Roy is editor of Sleep Review.

Photo: Regenstrief Institute investigators April Savoy, PhD, and Michael Weiner, MD, MPH, are health services researchers focusing on improving health care delivery. Credit: Regenstrief Institute


Savoy A, Patel H, Flanagan ME, et al. Comparative usability evaluation of consultation order templates in a simulated primary care environment. Appl Ergon. 2018 Nov;73:22-32.