A referral backlog is a queue of unprocessed referrals that a specialty group hasn’t worked through yet. These are incoming referrals that have yet to be scheduled or closed. Referral backlogs expand whenever referrals arrive at a faster rate than staff can work through them. As long as a referral stays buried in the backlog, that patient is left without the care they need, and it becomes more likely that they will choose a different provider altogether.
Also called: referral queue, unworked referrals, referral work queue
What causes a referral backlog?
Referral backlogs may occur for a variety of reasons, but here are some of the most common causes.
- Referral volume spikes: This is the most straightforward cause. When an unusually high amount of referrals comes pouring in, it can be difficult for an in-house staff to keep up.
- Staff turnover: On the other side of the equation, when a clinic loses critical staff who would be covering referrals, it makes it all the more difficult to keep up with the flow of referrals.
- Too many intake channels: There are many channels through which referrals can arrive, like phone, patient portals, or even fax. That can be convenient in many ways, but one drawback is that it forces staff to mind several different intake channels, potentially causing referrals to fall through the cracks.
- No ownership of referral age: When no one is keeping track of how long a referral has been in the backlog, it’s all too easy for a referral to get missed and go unprocessed for longer.
How is a backlog measured?
There are two numbers to keep track of when it comes to a referral backlog. The first is the total number of open referrals, and the other is the age of each referral, in days. Ideally, the open referrals should be organized by age by grouping them into ranges. For instance, 0 to 7 days old, 8 to 14, 15 to 29, and 30+ days old. This way, at a glance, staff can see the volume of open referrals and their distribution of age.
This grouping is useful because the particular age mix of a referral backlog matters more than the total number of referrals, as a small backlog of very old referrals is riskier than a large backlog of newer referrals.
Why does it matter?
Staying on top of your backlog expedites the referral intake process while saving relationships with both patients and referring offices.
- Referral leakage: Patients who stay in the backlog for too long are bound to become either impatient or in greater need of care, and will therefore look elsewhere.
- Delayed care for urgent patients: Patients who are in desperate need of care should be seen promptly. For many cases, delays in treatment aren’t just annoying, they can be dangerous.
- Strained relationships with referring offices: Referring offices prefer to send referrals to specialists who respond quickly and take care of the referred patients. By delaying referral intake, referring offices get the message that their patients won’t be getting the best, most attentive care from that specialist, and the referring provider might think twice about referring there in the future.
How are backlogs cleared?
To clear a referral backlog, the process is roughly as follows:
Triage by urgency and age
First, sort all of the open referrals in the backlog, first by how urgently the patient needs care, and second by the age of the referral. The most urgent and time-sensitive cases should be scheduled as soon as possible, since urgent health needs top someone’s place in line. Then, from the more routine referrals, they are sorted by age, oldest first since they’ve been waiting the longest.
Separate the backlog from new inflow
If there’s just one queue, filled with both old and new referrals, the backlog will continue to stay inundated, since there’s always new work pouring into it. Give the brand new referrals their own workflow that has its own standard target for turnaround time, as well as dedicated staff who are assigned to covering it. Meanwhile, other staff members are chipping away at the backlog. By keeping these queues separated, you can more easily stay on top of the current work while making measurable progress against the backlog.
Read More: How do I work down my referral backlog?
Close out referrals that can’t move forward
The reality of some referrals is that they won’t convert to new patients.
It’s best practice to close out a referral and remove it from the queue if a referred patient:
- Can’t be reached after repeated attempts at contact
- Has confirmed that they chose another specialist
- Has confirmed that they no longer need the care they were seeking
Referral backlog vs. referral leakage
The referral backlog refers to the queue of patient referrals that have yet to be scheduled, completed, or closed. Referral leakage is the result of losing referrals, either from the referred patient choosing another provider, not following through with their referral, or otherwise not being seen by the specialist.
FAQs
How old can a referral get before it’s likely lost?
There isn’t a hard and fast rule here that applies in all cases, but the likelihood of losing a referral goes up and up as time goes on. Many clinics will view unprocessed referrals as “at-risk” after 30 days, and anything past 60 days as very unlikely to convert to a new patient. However, it’s important for each clinic to determine its own thresholds based on the nature of its specialty and the urgency of individual patients’ needs.
Should urgent referrals be pulled out of the backlog?
Yes. Urgent referrals should not be queued as routine work. As soon as a referral is identified as urgent (based on clinical criteria), it should be pulled out of the normal queue and fast-tracked.
