THU007 Improving Completeness Of Endocrinology Referrals Using Structured Templates

Abstract Disclosure: K. Arao: None. V. Vimalananda: None. Objective: Endocrinologists rely on information in the referral to guide the focus and scope of their evaluations. However, endocrinology referrals frequently lack important clinical information, which may increase the risk of inefficiency, errors, and adverse outcomes. This quality improvement project aimed to improve the completeness of endocrinology referrals by utilizing structured referral templates for common endocrine conditions including diabetes, hypogonadism, osteoporosis, thyroid dysfunction (hyperthyroidism and hypothyroidism), and thyroid nodule. Methods: The project was implemented at a large Veterans Affairs Medical Center (VAMC) in New England. Structured referral templates were designed based on existing templates at other VA health systems, the American College of Physicians High Value Care Coordination Toolkit (developed in partnership with The Endocrine Society), and input from endocrinologists and primary care providers at the VAMC. Templates included fields for essential elements: a consult question, relevant clinical history and past medical history, type of visit preference, pertinent over-the-counter medications, and dates of relevant laboratory and imaging studies. We used functions including auto-population of data, checkboxes, and drop-down menus to ease usability. The templates were embedded into the electronic referral system. We conducted a retrospective chart review to compare referrals for a cohort of patients referred between 1/1/2021-9/1/2021 (pre-intervention) vs. a cohort referred between 10/1/2021-9/30/2022 (post-intervention). Each referral was rated using a scoring system derived from the criteria in the data abstraction tool formulated by the investigators. Results: On average, pre-intervention referrals included 52% of the essential elements and post-intervention referrals included 92%. Post-intervention referrals for diabetes, hypogonadism, osteoporosis, thyroid dysfunction (hyperthyroidism and hypothyroidism), and thyroid nodule improved from baseline by 44%, 45%, 39%, 39%, and 36% respectively. The greatest improvement was for the element “type of visit requested (one-time consultation, shared care, transfer of care, and consultant’s preference)”. A separate analysis excluding “type of visit” showed an average improvement from 64% of essential elements included pre-intervention to 92% included post-intervention. Conclusion: Structured referral templates embedded into an electronic referral system improves availability of essential information for the endocrine consultant. Our next steps are to modify the templates with the ongoing input of both endocrinologists and primary care providers. Future work should examine the effect of referral templates on specialist and primary care provider user experience, patient experience of care, efficiency, and clinical outcomes. Presentation: Thursday, June 15, 2023