Frustrated by poor quality referrals? An easy-to-use solution is spreading

June 10, 2019 Annabelle Wong

What if I told you the most common piece of missing information on a referral form is a clear reason for referral? With an average of two million referrals per year sent to the 5,405 specialists in Alberta, the burden of poor quality referrals can add up quickly.

Just one piece of missing information when referring a patient to another physician can delay a patient’s access to care. It can mean missed follow-ups, incomplete adherence to recommendations, duplicated services―and more paperwork for already busy physicians. When it comes to poor quality referrals, patients and physicians lose out.

The truth is, most Canadian physicians never receive formalized training or feedback on referrals. In Alberta specifically, medical students are given no consistent formal instruction about what is required for a quality referral.

So, what does a high-quality referral include? 

A clear reason for referral

What questions are you seeking consultation for? Is it diagnosis, management and/or treatment? Is the patient aware of the reason for referral? Express clear expectations for the consult outcome. Without it, you are more likely to get questions back, or receive no response at all―delaying care for your patient.

A summary of the patient’s current status

What do you think is going on? Is their condition stable, worsening or urgent? Include onset symptoms, their duration and any other key findings and red flags. This is the 'need to know' clinical information that has a direct impact on patient and referral status.

Any relevant finding and/or investigations

What actions were taken? Ensure you have listed any recently ordered tests so they aren’t ordered again. Highlight clinically relevant, pertinent positive and negative findings.

Current and past management with outcomes

Provide information on what you have tried previously―any successful or unsuccessful treatments, previous or concurrent consultations for this issue. This helps eliminate ineffective options quickly, duplicate efforts and gets the patient on an effective path faster.


To help determine the complexity and urgency of your referral, include the patient's medical history and concurrent medical problems. List other physicians involved as well as current and recent medications. Are there any situations that may prompt an earlier review? Think: allergies, warnings and challenges. The more information you give, the easier it will be for the referral to be prioritized.

A resource to use as a reference is Quality Referral Evolution, or QuRE’s (pronounced ‘cure’), evidence-informed Checklist―once printed, it fits right in your pocket. 

This Checklist is standardizing communication between physicians and specialists in Alberta―and it’s spreading! It has already informed a new template for a few EMRs in Alberta, with more to come. Soon, you might just have it built into yours too.


This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule.  Feel passionate about physician-led innovation? Please connect with us at

About the author(s)

Annabelle Wong

Annabelle Wong is passionate about improving the referral experience for patients across Alberta. Within the past four years, Annabelle has been a key contributor to the Quality Referral Evolution (QuRE) working group, a collaboration between family physicians, surgical and medical sub-specialties, the University of Alberta and University of Calgary and Alberta Health Services’ Access Improvement team. Together, their vision is to improve the quality of communication in the consultation/referral process. In her spare time, Annabelle is an avid traveler who recently came back from Prague, Vienna and Budapest. She also loves volunteering in her community and trying new coffee shops around Calgary.

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