Developing user-friendly ambulatory referrals: a quality improvement study in GI referral services at a large academic safety net hospital system
Abstract Background 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 the Grady Health System (GHS), our large safety net hospital system, the initial gastroenterology (GI) referral pr...
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BMC
2025-07-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-025-12976-3 |
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| author | Aaron Gerard Issac Wendy Du Alix Youngblood Wilhelmina Prinssen Kelly Carroll Robert Geller Palak Patel Bhavin Adhyaru Jason Brown |
| author_facet | Aaron Gerard Issac Wendy Du Alix Youngblood Wilhelmina Prinssen Kelly Carroll Robert Geller Palak Patel Bhavin Adhyaru Jason Brown |
| author_sort | Aaron Gerard Issac |
| collection | DOAJ |
| description | Abstract Background 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 the Grady Health System (GHS), our large safety net hospital system, the initial gastroenterology (GI) referral process suffered from multiple inefficiencies, creating barriers to care. We aimed to improve GI referrals with both a triage and a direct-to-endoscopy program to relieve systemic barriers to GI care at GHS especially around colorectal cancer screening. Methods Given wait times for GI services and employee dissatisfaction with navigating patients through the referral process, a GI smart order set was built using the Epic electronic medical record. The process took 8 months and included automated anesthesia screening as well as periprocedural guidance on blood thinners. We measured time from placement of referral for screening colonoscopy to scheduling of the screening colonoscopy to assess improvement in wait times for GI services. Key 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 the creation of multiple unofficial and only partially successful bypasses to expedite GI care. With the new GI smart order set, there was a 93% reduction over 12 months in the time from providers screening colonoscopy referral request to procedure scheduling from an average of 422 to 28 days. In addition, overall rates of colorectal cancer screening increased approximately 6% from 43.5 to 49% since the order set was implemented. Conclusions 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. This model can be used to improve triaging and increase access to GI and other specialist services. |
| format | Article |
| id | doaj-art-4d7cac8c7f954ec6a71218490ddf33d2 |
| institution | Kabale University |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-4d7cac8c7f954ec6a71218490ddf33d22025-08-20T03:37:20ZengBMCBMC Health Services Research1472-69632025-07-0125111010.1186/s12913-025-12976-3Developing user-friendly ambulatory referrals: a quality improvement study in GI referral services at a large academic safety net hospital systemAaron Gerard Issac0Wendy Du1Alix Youngblood2Wilhelmina Prinssen3Kelly Carroll4Robert Geller5Palak Patel6Bhavin Adhyaru7Jason Brown8Department of Medicine, Emory University School of MedicineDepartment of Medicine, Emory University School of MedicineDepartment of Medicine, Emory University School of MedicineGrady Health SystemGrady Health SystemDepartment of Pediatrics, Emory University School of Medicine and Grady Health SystemGrady Health SystemDepartment of General Medicine, Emory University School of Medicine and Grady Health SystemDivision of Digestive Diseases, Emory University School of Medicine and Grady Health SystemAbstract Background 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 the Grady Health System (GHS), our large safety net hospital system, the initial gastroenterology (GI) referral process suffered from multiple inefficiencies, creating barriers to care. We aimed to improve GI referrals with both a triage and a direct-to-endoscopy program to relieve systemic barriers to GI care at GHS especially around colorectal cancer screening. Methods Given wait times for GI services and employee dissatisfaction with navigating patients through the referral process, a GI smart order set was built using the Epic electronic medical record. The process took 8 months and included automated anesthesia screening as well as periprocedural guidance on blood thinners. We measured time from placement of referral for screening colonoscopy to scheduling of the screening colonoscopy to assess improvement in wait times for GI services. Key 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 the creation of multiple unofficial and only partially successful bypasses to expedite GI care. With the new GI smart order set, there was a 93% reduction over 12 months in the time from providers screening colonoscopy referral request to procedure scheduling from an average of 422 to 28 days. In addition, overall rates of colorectal cancer screening increased approximately 6% from 43.5 to 49% since the order set was implemented. Conclusions 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. This model can be used to improve triaging and increase access to GI and other specialist services.https://doi.org/10.1186/s12913-025-12976-3Electronic referralsDirect access endoscopyProgrammatic colon cancer screeningElectronic medical recordSafety net hospital |
| spellingShingle | Aaron Gerard Issac Wendy Du Alix Youngblood Wilhelmina Prinssen Kelly Carroll Robert Geller Palak Patel Bhavin Adhyaru Jason Brown Developing user-friendly ambulatory referrals: a quality improvement study in GI referral services at a large academic safety net hospital system BMC Health Services Research Electronic referrals Direct access endoscopy Programmatic colon cancer screening Electronic medical record Safety net hospital |
| title | Developing user-friendly ambulatory referrals: a quality improvement study in GI referral services at a large academic safety net hospital system |
| title_full | Developing user-friendly ambulatory referrals: a quality improvement study in GI referral services at a large academic safety net hospital system |
| title_fullStr | Developing user-friendly ambulatory referrals: a quality improvement study in GI referral services at a large academic safety net hospital system |
| title_full_unstemmed | Developing user-friendly ambulatory referrals: a quality improvement study in GI referral services at a large academic safety net hospital system |
| title_short | Developing user-friendly ambulatory referrals: a quality improvement study in GI referral services at a large academic safety net hospital system |
| title_sort | developing user friendly ambulatory referrals a quality improvement study in gi referral services at a large academic safety net hospital system |
| topic | Electronic referrals Direct access endoscopy Programmatic colon cancer screening Electronic medical record Safety net hospital |
| url | https://doi.org/10.1186/s12913-025-12976-3 |
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