Concerned about the lack of referrals to occupational therapy for patients with activities of daily living (ADL) deficiency, the occupational therapy section of an acutecare community hospital conducted a quality assurance study. Referral standards were established by the occupational therapy department and approved by the medical staff. Initial measurements indicated that 71 percent of patients requiring a referral did not receive it. Since the staff standard for missed referrals was only 15 percent, improvement actions were implemented. After improvements were made in the referral system, missed referrals dropped from 71 to 27 percent, marking an improvement of 44 points. The study produced several other benefits, including better communication among health care providers, improved patient functional assessment, and greater staff commitment to quality assurance activities.