Ep 56 - Intro to EM: How to refer a patient

Mastering the Art of Clinical Referrals: A Guide for Emergency Physicians Introduction Effective communication is crucial in the emergency department (ED), particularly when referring patients to inpatient teams. It not only ensures optimal patient care but also enhances professional relationships and personal job satisfaction. In this post, inspired by the St. Emlyns podcast, we'll explore a practical framework for making clinical referrals, emphasizing the importance of clear, structured communication. We'll discuss the SBAR (Situation, Background, Assessment, Recommendation) format, the concept of the "James Bond opening," and strategies for handling difficult conversations, all tailored to the fast-paced environment of emergency medicine. Why Effective Referrals Matter Referrals are an integral part of patient management in the ED. Every referral is made with the patient's best interest in mind, whether they need further investigations, specialized treatment, or simply continuity of care. Ensuring that the receiving team understands the urgency and context of the referral is vital. Good communication can influence how the inpatient team perceives the referring physician and can enhance collaborative relationships, leading to better patient outcomes and professional fulfillment. Setting the Stage: The James Bond Opening When initiating a referral, it’s essential to grab the attention of the receiving team quickly and effectively. This is where the "James Bond opening" comes in—start with a high-impact statement that summarizes the critical aspect of the patient's condition. For example, instead of saying, "I have a patient with abdominal pain," begin with, "I have a 25-year-old male who likely has appendicitis." This approach not only captures attention but also sets the stage for a focused and efficient conversation. The SBAR Framework: Structuring Your Referral The SBAR model provides a structured approach to communication, ensuring all essential information is conveyed succinctly. Here’s how to implement it: Situation Begin with a brief description of the patient's current condition. This is where the "James Bond opening" fits perfectly. Clearly state the key clinical concern that necessitates the referral. Background Provide context for the situation. This includes relevant medical history, the reason for the current ED visit, and any pertinent findings. For instance, you might say, "The patient has had two days of right iliac fossa pain and a history suggestive of appendicitis." Assessment Share your clinical judgment about the patient's condition. This not only demonstrates your understanding but also signals the expected pathway of care. In our example, "Based on the examination and symptoms, I believe the patient has appendicitis." Recommendation Conclude with a clear, direct request. Specify what you need from the inpatient team, such as a physical assessment, further diagnostic testing, or specific interventions. For instance, "I'd appreciate it if the surgical team could evaluate the patient for potential appendicitis and consider admission for further management." Enhancing the Referral Process: Tips and Tricks Introduce Yourself Clearly Always start the conversation by introducing yourself with your name and role. For example, "Hi, I'm Ian, one of the ED doctors." This personal touch helps build rapport and sets a friendly tone. If the receiving team introduces themselves by title only, politely ask for their name, fostering a more personable interaction. Predict and Prepare for Questions Anticipate the questions the receiving team might ask and prepare your responses. For example, if referring a potential appendicitis case, be ready to discuss symptoms, lab results, and physical findings. This not only streamlines the conversation but also demonstrates your preparedness and competence. Use the Illusion of Choice To smooth the referral process, offer options that guide the receiving team towards a d