A Web-based Generalist–Specialist System to Improve Scheduling of Outpatient Specialty Consultations in an Academic Center
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Failed referrals for specialty care are common and often represent medical errors. Technological structures and processes account for many failures. Scheduling appointments for subspecialty evaluation is a first step in outpatient referral and consultation.
We determined whether moving from paper-based referrals to a Web-based system with automated tracking features was associated with greater scheduling of appointments among referred patients.
Staggered implementation of a quality-improvement project, with comparison of intervention and control groups.
Patients 21 or more years of age referred from any of 11 primary-care clinics to any of 25 specialty clinics.
Faxed referrals were replaced by a Web-based application shared by generalists and specialists, with enhanced communications and automated notification to the specialty office.
We compared scheduling before and after implementation and time from referral to appointment. A logistic regression analysis adjusted for demographics.
Among 40,487 referrals, 54% led to scheduled specialty visits before intervention, compared to 83% with intervention. The median time to appointment was 168 days without intervention and 78 days with intervention. Scheduling increased more when duplicate referrals were not generated (54% for single orders, 24% for multiple orders). After adjustment, referrals with the intervention were more than twice as likely to have scheduled visits.
With a new Web-based referrals system, referrals were more than twice as likely to lead to a scheduled visit. This system improves access to specialty medical services.
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- A Web-based Generalist–Specialist System to Improve Scheduling of Outpatient Specialty Consultations in an Academic Center
Journal of General Internal Medicine
Volume 24, Issue 6 , pp 710-715
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- referral and consultation
- ambulatory care
- information systems
- Industry Sectors
- Author Affiliations
- 1. Indiana University Center for Aging Research, 410 West 10th Street, suite 2000, Indianapolis, IN, 46202-3012, USA
- 2. Regenstrief Institute, Inc., Indianapolis, IN, USA
- 3. Indiana University School of Medicine, Indianapolis, IN, USA
- 4. University Pediatric Associates, Indianapolis, IN, USA
- 5. Indiana University Medical Group, Indianapolis, IN, USA