High-value referrals: learning from challenges and opportunities of the COVID-19 pandemic: concept paper

Abstract

The referral system is a crucial component of health care systems, aiming to ensure patient access to specialist health care when needed, while maintaining resource efficiency. This concept paper examines various referral types, with a focus on high-value referrals that minimize wasteful activities. Referral is defined as a dynamic process in which a health professional at one level of the health system – having insufficient resources or power to decide on the management of a patient’s clinical condition – seeks the help of another facility at the same or higher level to assist in the care pathway. A series of indicators are proposed to monitor and benchmark different referral systems, considering presential and non-presential referrals (‎including e-referrals)‎ and classifying referrals by reason. The concept paper outlines the roles of referral system components, current issues, errors in practice, and suggestions for improvement. As part of the research, we conducted interviews with managers in different European health systems (‎Estonia, Italy, Malta, Spain)‎ to learn about how they leveraged or changed referrals during the pandemic and which changes they would propose. While no single “best” referral system exists, a set of good practices and their driving and inhibiting factors were identified, allowing stakeholders at different levels of the health system to assess how best to collaborate and integrate these practices into service provision. The report lists a series of 80+ potential areas for action to improve referral systems, classified by system components.