1. Implementing an electronic system for tracking and outreach to prevent adverse clinical outcomes attributable to delayed or incomplete follow-up on referrals¹ Scot B. Sternberg, MS, Daniel Leffler, MD, Kim Ariyabuddhiphongs, MD, Julia Navon, Sara Montanari, Eileen Joyce, Jennifer Beach, MD, Marc Cohen, MD, Louise Mackisack, MA, Paul Panza, Larry Markson, MD, Mark D. Aronson, MD Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA A teaching hospital of Harvard Medical School The Results/Progress to Date:  Leveraging an electronic referral tracking system with non-physician referral coordinators in a standardized work flow led to 30% increase in GI referral completion.  Non-physician staff can facilitate completion of referrals, thus reducing overall administrative burdens on primary care physicians and employing a top of license strategy.  Collaborations between primary care and specialties, physicians and administration, and IS are critical.  Plan to expand it to the larger practice (as resources allow) and pilot with additional specialties (Cardiology and Dermatology).  Conduct PDSA improvement cycles to identify potential opportunities to address barriers or gaps related to referrals not completed.  There had been no standard system for tracking patients referred for a consult, procedure or test.  The absence of a system to close the loop on high-risk referrals represents a significant risk for delay in diagnosis and/or treatment.  Cases of delay in diagnosis or treatment have been identified due to a delayed or incomplete referral and root cause analyses of these events have been conducted.  A review of 1000 previous referrals from primary care to gastroenterology revealed <40% were completed within a year.  Implement a tracking system and outreach for closed loop referrals  Improve completion rates as measured by the number and percent of referral orders tracked for outreach, scheduled, and completed by month.  In collaboration with representatives of teaching hospitals of Harvard Medical School, CRICO developed guidelines for referral management.  Based on the referral management guidelines (Figure 1), processes (Figure 2) were developed to ensure all 11 steps were reliably and promptly completed.  A workgroup including physicians and administrative staff from primary care, specialty services, and IS, developed the system.  The pilot was presented to two HCA teams and discussed at regular meetings to review and address any gaps or performance improvements.  A tool integrated within our electronic medical record was designed for tracking. Aim/Goal: Problem: Description of the Intervention, including context Results/Findings to date: Key Lessons Learned Next Steps For More Information, Contact Scot B. Sternberg, MS: sbsternb@bidmc.harvard.edu Figure 1. CRICO Referral Management Guidelines² Figure 2. BIDMC Referral Management Process Map ¹ This initiative has been funded, in part, by a grant from the CRICO patient safety program. ² CRICO (2012) Referral Management Guidelines, developed with contributions by the Referral Management Workgroup (RMW) members

4. Results/Findings to date