The Challenge
A review of referral data in the Gastroenterology Clinic revealed a troubling pattern: 83 percent of internally redirected referrals were being sent to the wrong service. There was no defined process for managing redirections, no obligation to inform referring providers, and no communication to patients left waiting without understanding what had happened.
The waitlist no longer reflected actual demand. Patients experienced unexplained delays, clinicians carried unnecessary administrative burden, and the integrity of the access system had eroded to the point where it could not be trusted.
The Approach
A quality improvement initiative redesigned referral flow and established clear, enforceable expectations for communication at every stage:
- A standardized workflow was created within the electronic message center for documenting and communicating all referral redirections
- Physicians were required to review established clinical criteria before redirecting any referral
- Referring providers were required to be informed of the appropriate next steps at every redirection
- Standard work required referring providers to update patients and families on the status of their referral
- Physicians were encouraged to include richer clinical detail in referrals at submission, reducing the need for redirection before it occurred
The Outcome
Internally redirected referrals decreased by more than 50 percent. Communication compliance among GI physicians reached 100 percent through consistent use of the message center.
The waitlist became accurate for the first time, reflecting only active patients genuinely awaiting care.