Nurse Practitioner Consultation and Referral
Practice Guidelines
Consultation and referral is an important communication process among healthcare providers providing an effective
way to share information and seek guidance about a client’s health concerns. While the purpose of consultations and
referrals are slightly different, as noted below, their key elements are similar.
In Nova Scotia, consultation and referral is within the nurse practitioner’s (NP) legislated scope of practice (RN Act,
2006; RN Regulations, 2009). According to the Nurse Practitioner Standards of Practice, nurse practitioners:
Collaborate, consult with and refer clients to the most appropriate health professional when they
determine that another professional’s expertise is required for competent and safe client care. Prior to
acting on advice from another health professional, nurse practitioners are required to evaluate these
recommendations in light of a client’s current situation and health care preferences. In addition, nurse
practitioners accept referrals and requests for consultation from other healthcare providers and are
accountable for the advice and recommendations they provide. Consultations may occur in person, by
telephone, in writing or electronically, as appropriate to individual situations (CRNNS, 2014).
This guideline provides an approach to the format and content for preparing consultations and referrals to healthcare
colleagues, including physicians and specialists.
Consultation versus Referral
A consultation is a request for another health professional’s advice to support a client’s care. The consultant may
or may not see the patient directly. The responsibility for clinical outcomes remains with the NP who initiates the
consultation and who may accept or reject the advice of the consultant (CRNNS, 2014).
A referral is an explicit request for another health professional to become involved in the care of a client by
transferring care or aspects of care to the professional whose expertise is more appropriate to the client’s healthcare
needs. The responsibility for client management may be negotiated but responsibility is usually assumed by the health
professional accepting the referral (Barron & White, 2009).
Components of a Consultation or Referral
Consultations and referrals should be prepared with the intended health professional in mind. The required client
information may differ depending on the type of healthcare provider being contacted, and in some instances,
not all information will be available. Whether communicated in person, by telephone, in writing or electronically,
consultations or referrals should contain the following information (College of Physicians and Surgeons of Nova
Scotia, 2010; College of Family Physicians of Canada, 2009; University of Manitoba, 2014):
•
Demographic data, including the client’s date of birth, gender, contact information (address and telephone
number), Nova Scotia Medical Services Insurance (MSI) number (or other provincial healthcare number as
appropriate).
•
Reason for the consultation/referral in a succinct statement that summarizes the client’s problem.
•
History of the presenting problem to describe the chief complaint, associated symptoms and relevant history,
comorbidities, etc.
© 2015, College of Registered Nurses of Nova Scotia, Halifax, Nova Scotia. All rights reserved. This document
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•
Past medical, surgical and psychosocial history (e.g. work, travel, lifestyle, etc.) relevant to the client’s problem
for which the consultation / referral is being requested.
•
Medications, including prescription, over-the counter, and herbal products.
•
Allergies and intolerances, including reactions.
•
Relevant physical examination findings related to the client’s problem
•
A list of all laboratory and diagnostic imaging tests that have been completed including results if not available
to the consultant as well as any pending investigations.
•
A summary of any management interventions to date and the client’s response to therapy
•
Established or differential diagnoses relevant to the consultation/referral request.
•
The expectation of the consultation/referral (e.g. whether the request is for assessment and advice only or for
transfer of care to the consultant), including plans for follow-up
While waiting for the consultation or referral appointment, the NP remains responsible for their client’s care. If the
client’s condition changes while awaiting the appointment, the NP is accountable to update the consultant with any
new information.
If the consultation or referral is of an urgent nature, the NP should attempt to contact the consultant directly by
telephone and then provide written follow-up to summarize and document the conversation.
The style of consultation and referral letters should have a professional, not conversational, tone and present relevant
information succinctly and in a logical sequence to facilitate the recipient’s efficient review of the request.
The NP sending the consultation or referral is accountable to confirm that their contact information is accurate to
ensure any reports from the consultation/referral are returned to them.
Effective communication among all health professionals involved in the management of a client’s care is essential to
the provision of safe and comprehensive care. As an NP, these guidelines will help minimize interprofessional role
confusion and maximize collaboration, time and resources that can be re-allocated to the delivery of safe, client care.
References
College of Family Physicians of Canada. (2009). Guide to Enhancing Referrals and Consultations between Physicians.
Retrieved from: http://www.cfpc.ca/uploadedFiles/Resources/Resource_Items/Health_Professionals/Guide%20
to%20enhancing%20referrals%20and%20consultations%20between%20physicians.pdf
College of Physicians of Nova Scotia. (2014). Guidelines for Physicians Regarding Referral and
Consultation. Retrieved from http://www.cpsns.ns.ca/DesktopModules/Bring2mind/DMX/Download.
aspx?PortalId=0&TabId=129&EntryId=47
University of Manitoba. (2014). Self-study module: Consult and referral request letters. Winnipeg, MB: Author.
© 2015, College of Registered Nurses of Nova Scotia, Halifax, Nova Scotia. All rights reserved. This document
may be downloaded from the CRNNS website. Portions of this publication may be reproduced for personal use.
Reproduction of this document for other purposes, by any means, requires permission of the copyright owner.
CRNNS.CA
2