Implementation of a 3-Tier Priority System for Emergency Department Patients’ Follow-up in Orthopaedic Surgery
Introduction: Increasing demand for emergency department (ED) services and strained specialty-care access requires referral precision and was the impetus for a collaborative redesign of referrals between the Department of Emergency Medicine and Department of Orthopaedic Surgery. Methods: Guided by r...
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| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
eScholarship Publishing, University of California
2025-07-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/3rc8x38s |
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| Summary: | Introduction: Increasing demand for emergency department (ED) services and strained specialty-care access requires referral precision and was the impetus for a collaborative redesign of referrals between the Department of Emergency Medicine and Department of Orthopaedic Surgery. Methods: Guided by root cause analysis of delays in post-emergency department (ED) specialty follow-up in our academic health system, the intervention targeted the finding that all ED referrals were marked “ urgent” without differentiation by acuity of orthopedic issues. After implementation, referrals were triaged into three tiers— immediate, urgent, and routine—with stipulated follow-up timeframes. We evaluated differences in completion of scheduling and realized visits, across five calendar months (July–November) pre- and post-implementation (2021 vs 2022). Logistic regression assessed the relationship between patient demographics and outcomes. We report medians and interquartile ranges. Results: Compared to the 393 urgent referrals to the Department of Orthopaedic Surgery pre-implementation, there were 463 total referrals post-implementation as follows: 11/463 (2.4%) marked as immediate; 123/463 (26.6%) u rgent; and 329/463 (71.1%) r outine. Similar proportions successfully scheduled pre- and post-implementation (41.5% vs 45.1%; P = .28). On average, immediate referrals completed scheduling within 1.0 (0.0 – 1.0) day and were seen in 4.0 (2.0 – 8.0) days, urgent referrals completed scheduling within 2.0 (1.0 – 4.0) and 7.0 (5.0 – 15.0) days, and routine within 3.0 (1.0 – 6.0) and 12.0 (6.0 – 19.5) days. Race/ethnicity and insurance were related to odds of successful scheduling; Black patients had lower odds than all other groups (odds ratio [OR] 0.3 – 0.4). All insurance categories had higher odds of successful scheduling relative to Medicaid out-of-network (OR 3.5 – 7.2). Conclusion: A three-tier ED-to-orthopedics referral triage system was quickly adopted and differentiated referrals by urgency but did not impact time to follow-up or loss to follow-up. Structural inequities in access to follow-up care remain. |
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| ISSN: | 1936-900X 1936-9018 |