Closing the Loop: Successful Referrals

Lacey Coffin Greene
Program Manager, WCAAP

Until the magical day when all our systems work seamlessly together, it’s up to providers to figure out if their referrals are successful.  Many specialty clinicians are good at looping back around.  But without standard work and built in process flow, it’s hard to do this consistently.

The Physician Consortium for Performance Improvement (PCPI) and the Wright Center for Graduate Medical Education worked with 12 dyads of primary and specialty care providers to identify models, techniques, and tools to facilitate successful closed loop referrals.  The dyads represented 9 different EHRs.  The project’s product is a toolkit to inform efforts to improve the referral process, including comprehensive suggestions for a care compact between providers, quality improvement tools, and change concepts.  You can find the complete toolkit here. A successful closed loop referral looks like this:

Conclusions from the project include the essential role of the physician to promote and support change, the importance of explicit expectations of referral staff, active customization and use of the EHR, the value of the clinical question, and patient engagement.

Components of a successful closed loop referral are:

  1. Reason for referral clearly stated
  2. Referral sent to specialty care in a timely manner with supporting information included
  3. Specialist response addresses the reason for referral
  4. Referral report back to PCP sent in a timely manner
  5. PCP, specialist, and patient/family are satisfied
  6. EHR support for referral process is maximized

We pulled some tools from the Closed Loop Referral product for easy reference; you can find those here.  There’s an example of a bidirectional referral form between primary and behavioral health care which creates a closed loop in our P-TCPI Pediatric Provider Toolkit at .

For more information about the Closed Loop Referral Project, email Feel free to contact Lacey at