title: ASSESSING REFERRALS AND IMPROVING INFORMATION AVAILABILITY FOR CONSULTATIONS IN AN ACADEMIC ENDOCRINOLOGY CLINIC.
abstract: OBJECTIVE
  Outpatient specialty consultations rely on the timeliness and completeness of referral information to facilitate a valuable patient-specialist interaction. This project aimed to increase essential diagnostic information availability at the initial consultation for patients referred for common endocrine conditions frequently lacking such data-diabetes mellitus, thyroid nodule, thyrotoxicosis, and hypercalcemia.
  
  
  METHODS
  At an endocrinology clinic at an academic medical center in rural New England, providers see several thousand new patients annually, the majority of whom are referred by providers external to the clinic's healthcare system. Through consensus, endocrinology clinic providers agreed on the two or three data elements essential for a meaningful initial consultation for each. A quality improvement team employed a planned series of interventions based on previously published methods and an innovative approach: dissemination of a referral guideline, an assessment of referral adequacy in the endocrinology clinic workflow, coupled with focused requests for missing items, and a pre-visit lab appointment.
  
  
  RESULTS
  Between April 2015 and March 2016, 762 referrals were reviewed. At baseline for the four conditions, referrals contained all essential elements only 27.5% (22 of 80) of the time. Over a 7-month period, the team implemented the interventions, with subsequent referrals containing all essential elements increasing to 75.5% (P<.0001), largely attributable to the pre-visit lab appointment.
  
  
  CONCLUSIONS
  Incoming referrals that lack essential information are a significant problem in specialty care and may adversely affect patient experience, provider satisfaction, and clinic efficiency. Improvement may require innovative approaches, such as the potentially transferable and generalizable ones employed here.
  
  
  BACKGROUND
  DHMC = Dartmouth-Hitchcock Medical Center EHR = electronic health record PDSA = Plan-Do-Study-Act.
authors.forename: Chase D
authors.initials: CD
authors.lastname: Hendrickson
authors.forename: Saumya
authors.initials: S
authors.lastname: Saini
authors.forename: Avin
authors.initials: A
authors.lastname: Pothuloori
authors.forename: John N
authors.initials: JN
authors.lastname: Mecchella
mesh_terms: D000046:Academic Medical Centers; D000553:Ambulatory Care; D000554:Ambulatory Care Facilities; D057286:Electronic Health Records; D004700:Endocrine System Diseases / Q000628:therapy*; D004704:Endocrinology / Q000706:statistics & numerical data* / Q000639:trends; D017408:Guidelines as Topic; D006801:Humans; D033181:Information Dissemination; D008499:Medical Records; D009513:New Hampshire; D058996:Quality Improvement; D012017:Referral and Consultation / Q000706:statistics & numerical data* / Q000639:trends; D016896:Treatment Outcome; D057188:Workflow