Use of Structured Templates to Improve Completeness of Endocrinology Referrals

Kevin A Arao; Denise H Wong; Jolie B Wormwood; Varsha G Vimalananda

doi:10.1016/j.eprac.2023.05.010

Use of Structured Templates to Improve Completeness of Endocrinology Referrals

Endocr Pract. 2023 Aug;29(8):623-628. doi: 10.1016/j.eprac.2023.05.010. Epub 2023 May 30.

Authors

Kevin A Arao¹, Denise H Wong², Jolie B Wormwood³, Varsha G Vimalananda⁴

Affiliations

¹ Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts; Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts. Electronic address: arao.kevin@gmail.com.
² Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts.
³ Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts; Department of Psychology, University of New Hampshire, Durham, New Hampshire.
⁴ Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts; Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts.

PMID: 37263393
DOI: 10.1016/j.eprac.2023.05.010

Abstract

Objective: Endocrinology referrals frequently lack important clinical information, which may increase the risk of inefficiency and adverse outcomes. This quality improvement project aimed to improve the completeness of new referrals by utilizing structured referral templates for common endocrine conditions at a large Veterans Health Administration medical center. Our target was of at least a 30% improvement in referral completeness for each condition after the intervention.

Methods: Electronic structured referral templates were designed utilizing existing resources and input from primary care providers and endocrinologists. Essential elements were identified and included in the templates. We conducted a retrospective chart review to compare referrals for 125 patients referred between January 1, 2021 and September 1, 2021 (preintervention) and 125 patients referred between October 1, 2021 and September 30, 2022 (postintervention). Each referral was rated using a scoring system derived from the criteria in the data abstraction tool formulated by the investigators.

Results: On average, preintervention referrals included 52% of the essential elements and postintervention referrals included 93%. Improvements in referral scores for each condition all met the prespecified 30% improvement target. The greatest improvement was for the element "type of visit preference." A separate analysis excluding that element showed an average improvement from 64% of essential elements preintervention to 92% postintervention.

Conclusion: Structured referral templates, designed with the input of primary care providers and endocrinologists and embedded into an electronic referral system, can improve the availability of essential information and increase the quality of referrals. Future work should examine the effect of structured referral templates on efficiency, specialist experience, patient experience of care, and clinical outcomes.

Keywords: endocrinology referrals; quality improvement; referral templates.

MeSH terms

Endocrine System Diseases* / diagnosis
Endocrine System Diseases* / therapy
Endocrinologists
Endocrinology*
Humans
Referral and Consultation
Retrospective Studies