Clinical Resources for Clinicians · For clinicians

How to Set Up a Hematology Referral Workflow for an OB/GYN Practice

By the Find Her Doctor editorial team · Updated November 1, 2026 · 6 min read

A good hematology referral workflow has five parts: triage tiers that match urgency to gestational age, a standard referral packet, a separate fast-track route for IV iron, a named coordinator at each practice, and closed-loop communication so every referral ends with a documented plan. Build it once with your hematology partner and it saves weeks per patient.

Most practices already have a hematologist they call. What they usually don't have is a system, and the difference shows up in the third trimester.

Where ad hoc referrals break down

The failure modes are remarkably consistent from practice to practice:

• Wrong door. An uncomplicated IV iron request lands in the general consult queue and waits weeks.
• Incomplete packet. The hematology office calls back for labs, and days go by.
• Lost in transit. The referral goes out, and nobody confirms the appointment was made or kept.
• No plan back. The consult happens, but the delivery plan never reaches L&D.
• Gestational clock ignored. A referral that's routine at 14 weeks gets treated as routine at 35 weeks.

Each step below targets one of these.

Step 1: Define referral tiers

Agree with the hematology practice on a few tiers and what each means operationally.

Clinical criteria for each are in our hematology referral checklist.

Step 2: Build the IV iron fast track

For most OB practices, separating IV iron from consults is the single highest-yield change. It's also easy to skip, because it requires an upfront conversation about criteria.

Agree on criteria for direct-to-infusion referral, for example:

• Ferritin-confirmed iron deficiency, with or without anemia
• Second trimester or later, or postpartum
• Oral iron failure, intolerance, malabsorption or late presentation
• No red flags: normal WBC and platelets, no hemolysis, no unexplained macrocytosis

Agree on what the infusion team owns: product selection within formulary, benefits verification, prior authorization, scheduling and post-infusion labs. Our prior authorization guide covers the documentation.

Agree on escalation: which findings during the infusion pathway trigger a full hematology review.

Clinical background: IV iron in pregnancy.

Step 3: Standardize the referral packet

Build an EHR order or template that pulls in:

• The specific question, and the tier
• Gestational age, EDD, planned delivery hospital
• CBC trend with indices; ferritin, TSAT; smear if available
• Coagulation studies, VWF studies, hemoglobinopathy results as relevant
• Iron treatment history: product, dose, dates, response
• Medications, including anticoagulants and aspirin
• Bleeding and VTE history; family history
• Insurance and preferred site
• Patient language and contact preferences
• Best contact for the referring clinician

A complete packet lets the first visit make decisions instead of reordering labs. "Anemia, please eval" with no ferritin attached is the referral equivalent of a missed week.

Step 4: Name coordinators

• OB practice: a nurse or referral coordinator who sends referrals, confirms appointments and tracks outcomes. Often the same person who runs the outpatient anemia protocol.
• Hematology practice: a named intake contact who confirms receipt, schedules and escalates.
• Clinician-to-clinician line: a direct number or secure messaging channel for questions that don't need a visit. Many referrals turn out to be a five-minute curbside conversation once this exists.

Step 5: Close the loop

Every referral should end with a documented response:

1. Receipt confirmed within one business day
2. Appointment date sent to the referring office
3. Consult note or infusion summary returned, with the plan stated plainly
4. Peripartum plan, where relevant, filed where L&D and anesthesia will actually see it. This is critical for VWD, anticoagulation, thrombocytopenia and sickle cell disease.
5. Postpartum handoff: who follows the patient after delivery, and for how long

The OB coordinator reviews open referrals weekly and chases anything not closed.

Step 6: Put co-management roles in writing

For conditions that span the pregnancy (anticoagulation, sickle cell disease, ITP, VWD), write down who does what:

"Agreed in advance" is doing a lot of work in that table. Ambiguity there is where patients fall through. See anticoagulation in pregnancy for a worked example.

Step 7: Measure it

Track a few metrics quarterly:

• Days from referral to first hematology visit, by tier
• Days from IV iron order to infusion
• Share of referrals with a complete packet on first submission
• Share of expedited pregnancy referrals with a delivery plan filed before 36 weeks
• Patients anemic at admission for delivery

Review them jointly with your hematology partner and adjust tiers or criteria as needed. The last metric is the one that tells you whether the whole system is working.

The patient side

• Explain the referral. A referral to a "hematology & oncology" practice can frighten patients who assume it means cancer. One sentence from you ("this is about your iron, and they also run the infusion center") prevents a lot of no-shows.
• Offer the closest site. Transport and childcare are real barriers, especially for patients relying on the subway, buses, or a single family car on Long Island or in the Hudson Valley.
• Use the patient's language. Provide materials in it, and confirm the hematology office can provide interpretation.

Common setup mistakes

• Building it around one clinician. If one physician holds all the relationships, referrals stall when that person is on vacation. Put it in the template and the system.
• Skipping the IV iron fast track. Sending every iron referral through a full consult is the most common cause of third-trimester delays.
• No feedback loop. If the hematology note never reaches the OB chart, or the plan is buried in a scanned PDF, the workflow fails at delivery.
• Leaving out L&D and anesthesia. Peripartum plans need a home the inpatient team actually checks.
• Not reviewing the data. Turnaround times drift. A quarterly look keeps everyone honest.

A 30-day launch plan

1. Week 1: meet with the hematology partner to agree on tiers, IV iron criteria and contacts.
2. Week 2: build the EHR referral template and IV iron order set, and set up the tracker.
3. Week 3: train clinicians, nurses and front-desk staff; hand out one-page reference cards.
4. Week 4: go live, then hold a short check-in after the first 10–20 referrals to fix gaps.

After launch, fold the referral metrics into your regular quality meetings, and keep the workflow in a short shared document that both practices update when staff change.

Referral partnership in New York

This is much easier with a partner already set up for it. Premier Hematology & Oncology, which sponsors our professional resources, works with OB/GYN practices on referral pathways, IV iron infusions and co-management, with infusion centers across New York City, Long Island and the Hudson Valley. Start the conversation through our hematology partners page.

Frequently asked questions

Sources

• ACOG — Anemia in Pregnancy (Practice Bulletin No. 233)
• ACOG — Thrombocytopenia in Pregnancy (Practice Bulletin No. 207)
• ACOG — Thromboembolism in Pregnancy (Practice Bulletin No. 196)
• ACOG — Optimizing Postpartum Care (Committee Opinion No. 736)
• AHRQ — Care coordination measures and closed-loop referral concepts

This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.