Characterizing barriers to closing cross-institutional referral loops: Workflow and information flow analysis

Cassandra McCormack; April Savoy; Anna Mathew; Alexis Marcum Gilmore; Elizabeth Cottingham; Amee Sangani; Barrett Caldwell; Richard J Holden; Michael Weiner

doi:10.1016/j.apergo.2023.104177

Characterizing barriers to closing cross-institutional referral loops: Workflow and information flow analysis

Appl Ergon. 2024 Feb:115:104177. doi: 10.1016/j.apergo.2023.104177. Epub 2023 Nov 27.

Authors

Cassandra McCormack¹, April Savoy², Anna Mathew³, Alexis Marcum Gilmore⁴, Elizabeth Cottingham⁴, Amee Sangani⁵, Barrett Caldwell¹, Richard J Holden⁶, Michael Weiner⁷

Affiliations

¹ Purdue University School of Industrial Engineering, West Lafayette, IN, USA.
² Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indiana, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA; Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA. Electronic address: asavoy@iu.edu.
³ Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indiana, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA.
⁴ Regenstrief Institute, Inc., Indianapolis, IN, USA.
⁵ Regenstrief Institute, Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA.
⁶ Regenstrief Institute, Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.
⁷ Regenstrief Institute, Inc., Indianapolis, IN, USA; Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA.

Abstract

The specialty referral process consists of primary care clinicians referring patients to specialty consultants. This care transition requires effective care coordination and health information exchange between care teams; however, breakdowns in workflow and information flow impede "closing the referral loop" and delay or prevent referrers from receiving the consultant's "visit notes," particularly in cross-institutional referrals. This study aimed to describe and map the referral process as it occurs in clinics and identify and characterize work system barriers affecting its performance. Referrers and consultants were interviewed about their perceived workflows, barriers, and clinical outcomes to inform a workflow analysis.

Keywords: Human Factors Engineering; SEIPS framework; Specialty referral process; Work systems.

MeSH terms

Health Facilities*
Humans
Referral and Consultation*
Workflow

Abstract

MeSH terms

Grants and funding