P1233 - Developing User-Friendly Ambulatory Referrals: A Pilot Study in Gastroenterology Referral Services at a Large Academic Safety Net Hospital System

Aaron Issac, MD¹, Wendy Du, MD¹, Alix Youngblood, MD¹, Wilhelmina Prinssen, MD², Daniel Wu, MD¹, Kelly Carroll, MD², Bhavin Adhyaru, MD¹, Jason Brown, MD^3
1Emory University School of Medicine, Atlanta, GA; ²Grady Health System, Atlanta, GA; ³Emory University, Atlanta, GA

Introduction: In the United States, more than a third of patients are referred to specialists each year; however, most of these referrals do not lead to completed appointments. At large safety net hospital systems, such as Grady Health System (GHS), the gastroenterology (GI) referral process suffers from multiple inefficiencies creating barriers to care. We aim to improve GI referrals to relieve systemic barriers at GHS.

Methods: GHS providers who interacted with the original GI referral process were sent a pre-implementation survey. The initial survey was completed by 56 employees, with attending faculty (41) that were primary care doctors (27), other subspecialists (14), and other specialties (15). Given wait times for GI services and employee dissatisfaction a GI smart order set was built using the Epic electronic medical record (EMR). The process took 8 months, with built in anesthesia screening, as well as periprocedural guidance on blood thinners. To assess for improvement in wait times for GI services we measured time from screening colonoscopy to scheduling of the procedure.

Results: In our pre-implementation survey, 60% of providers placed at least one urgent referral a month, and 55% of providers were either somewhat or very dissatisfied with the referral process. This led to multiple system bypasses including contacting providers directly. The final EMR order set simplified logic is seen in figure 1. The GI referral pathways branch points include whether the provider needs clinic or procedural services, for the procedural pathway whether the indication is diagnostic or for screening, and then both assess for urgent vs. nonurgent referrals. With the new GI smart order set, there was an 85% reduction over 6 months in the time from providers screening colonoscopy referral request to procedure scheduling from 203 to 31 days (Table 1).

Discussion: This novel outpatient GI referral smart order set addressed multiple barriers to care and created a novel triage mechanism as well as a direct-to-endoscopy referral stream. There was also dynamic monitoring within the EMR with monthly administrative reports, collecting data about smart order set usage and referral volumes to assist with allocation of staffing and funds. Future improvements include a dedicated scheduling coordinator and closed loop communication with referring providers. This model can be used to improve triaging and increase access to GI and other specialist services.




Disclosures:


Aaron Issac, MD¹, Wendy Du, MD¹, Alix Youngblood, MD¹, Wilhelmina Prinssen, MD², Daniel Wu, MD¹, Kelly Carroll, MD², Bhavin Adhyaru, MD¹, Jason Brown, MD³. P1233 - Developing User-Friendly Ambulatory Referrals: A Pilot Study in Gastroenterology Referral Services at a Large Academic Safety Net Hospital System, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.