Underreferral

Underreferral is the failure to refer a patient, client, or case to an appropriate level of care, service, or professional when such referral is clinically indicated, policy-mandated, or necessary for safety. The term is used in healthcare, mental health, social services, and related fields to describe situations where guidance or thresholds for referral are not followed or are insufficiently acted upon.

In healthcare, underreferral can occur when primary care clinicians do not refer patients with red-flag symptoms, unusual test results, or high-risk conditions to specialists, diagnostic services, or urgent care. In mental health or social services, it may involve not connecting individuals to therapy, crisis intervention, protective services, or community supports despite evident need. Causes include limited access to specialists, unclear referral pathways, time pressures, cognitive biases, misinterpretation of guidelines, and fragmented care coordination.

Consequences can be substantial, including delayed diagnosis, progression of disease, poorer outcomes, unnecessary suffering, higher emergency care use, and increased system costs. Ethically and legally, underreferral can raise questions about duty of care and equity of access, particularly for vulnerable populations.

Prevention and mitigation focus on clear referral criteria and pathways, decision support tools, routine audits of referral patterns, staff training, and integrated care networks that reduce fragmentation. Transparent triage, timely feedback loops, and patient advocacy help ensure that referrals occur when needed. Underreferral is the counterpart to overreferral, and both relate to the appropriateness and efficiency of care delivery.