Meaningful use of the EHR-Evaluating the internal and external factors affecting the timeliness of patient referrals
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With increasing numbers of patients seeking healthcare in the ambulatory setting it is necessary to evaluate processes for improving efficiency and access, while controlling costs. Timely access to specialty care is vital to patient satisfaction, preventing duplication of services and providing quality patient care. Referral processes from PCP’s to specialists can be flawed as a result of deficits in coordination of services, poor communication between providers, and a lack of standardization of processes and forms.
This project aimed to evaluate specialty referral wait times in a large academic medical center. Internal (organizational) as well as external (patient specific) factors were examined. Additionally, although specific to this QI project, the need to examine the accuracy of EHR data was identified and included. A retrospective review of one month of referral data to five medical specialties was completed (n=752). Logistic regression and multivariable analysis was used to determine whether age, race, insurance, specialty, or days from referral to appointment were associated with delays to timely access. Referrals with significant delays were further reviewed to identify additional factors associated with the delays.
Delays were seen in processing the referral at the referring provider’s office as well as in the triage process at the receiving office. Hospital discharge referrals and established patients requiring authorization for a follow up visit were erroneously categorized into the new referral data.
Nurse leaders, as patient advocates with interdisciplinary partnerships, are well positioned to improve the reliability and efficiency of the referral process in the ambulatory setting. It is important to leverage electronic data to improve quality and safety. This information is used by nurse managers for process improvement at the clinic level, highlighting the importance of defining metrics so inappropriately categorized data is not acted upon.
Type | Thesis |
Acquisition | Proxy-submission |
Review Type | None: Degree-based Submission |
Format | Text-based Document |
Evidence Level | Quality Improvement |
Research Approach | Translational Research/Evidence-based Practice |
Keywords | Electronic Health Records; Patient Referrals; Referrals Wait Time; Nurse Leaders |
Grantor | University of California, Davis |
Advisor | Hodge, Margaret; Kim, Tae Youn; Ward, Deborah |
Level | Master's |
Year | 2016 |
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