Creating Clinical Pull: Improving Timely Referral to Specialty Services to Improve Patient Outcomes

Coordination of primary, specialty, and subspecialty care is a central component to ensure that patients receive timely and effective treatment. In relation to referrals for specialty care, gaps in clinical decision-making, information management, and patient flow between primary, specialty, and subspecialty care can contribute to deficiencies in health services delivery. Strategies to address these gaps have largely focused on the referring provider and processes to improve the coordination of referred patients. These strategies have failed to mitigate delayed or absent referrals, defined by clinical settings in which a referral to specialty or subspecialty care is warranted but is delayed or not made. To address this persistent care delivery challenge, Allina Health Minneapolis Heart Institute developed an alternative strategy informed by pull systems in Lean production that leverage the expertise of specialists to pull patients toward needed clinical care, rather than relying on the primary or specialty care provider to refer, or push, the patient toward that care. This model has promise to address persistent instances of delay or failure to use specialty and subspecialty services in high-risk clinical scenarios while also enhancing efficiency and minimizing disruptions in clinical workflow.