A Web-based Generalist–Specialist System to Improve Scheduling of Outpatient Specialty Consultations in an Academic Center

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Abstract
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.