Focus Area: Referrals

change concept, change idea, tools and resources.Referrals strategies are approaches aimed at bolstering cardiac rehabilitation (CR) referral. These include using standardized processes, electronic referrals, and health system data to drive improvement.

Note: Change concepts are general notions that are useful in the development of more specific ideas for changes that lead to improvement. Change ideas are actionable, specific ideas or strategies for changing a process. Each change idea lists evidence- or practice-based tools and resources that can be adapted by or adopted in a health care setting to improve CR utilization.

Referrals: Change Concepts

Incorporate Referral to CR into Hospital Standardized Processes of Care for Eligible Patients

Change Idea:
Include referral to CR in order sets for appropriate patients; incorporate into EHR as appropriate

Tools & Resources:


Change Idea:
Include referral to CR in discharge checklists for appropriate patients; incorporate into EHR as appropriate

Tools & Resources:


Change Idea:
Include referral to CR in appropriate patient discharge forms; incorporate into EHR as appropriate

Tools & Resources:


Change Idea:
Develop a standard process for informing an external CR program of a referred patient

Tools & Resources:


Change Idea:
Develop a standard process for eligible patients to self-refer to CR

Tools & Resources:

Standardize the CR Referral Process

Change Idea:
Develop and communicate a standardized referral process or policy for patients

Tools & Resources:


Change Idea:
Develop and communicate a standardized outpatient CR referral process or policy for patients discharged to inpatient acute or subacute rehabilitation or to homecare services

Tools & Resources:


Change Idea:
Implement standardized paper/faxed referral to CR from an inpatient setting

Tools & Resources:


Change Idea:
Implement standardized paper/faxed referrals to CR from an outpatient setting

Tools & Resources:


Change Idea:
Use inpatient EHR tools to automate referrals to CR for all eligible patients including default or “opt out” orders for patients with qualifying diagnoses

Tools & Resources:


Change Idea:
Use outpatient EHR tools to automate referrals for patients with qualifying diagnoses who have not participated in CR

Tools & Resources:

Use Data to Drive Improvement in Referrals to CR

Change Idea:
Determine inpatient referral metrics to CR

Tools & Resources:


Change Idea:
Determine outpatient referral metrics to CR

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Change Idea:
Use CR referral performance measures in a quality improvement system

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Change Idea:
Regularly provide a dashboard with CR referral metrics, goals, and performance

Tools & Resources:


Change Idea:
Implement a CR Registry to identify, track, and manage patients who are referred to a CR program

Tools & Resources:


Change Idea:
Identify patients who had a cardiac event without a referral to a CR program

Tools & Resources:

Bold font indicates CR programs that contributed content.

Note: References for citations on this page can be found under Additional Resources and References.


Additional Focus Areas

Learn more about the other Cardiac Rehabilitation Change Package (CRCP) focus areas:

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