• Michael Weiner, Georges El Hoyek, Lynnette Wang, Paul R Dexter, Ann D Zerr, Anthony J Perkins, Felgrace James, and Rattan Juneja.
• Indiana University Center for Aging Research, 410 West 10th Street, suite 2000, Indianapolis, IN, 46202-3012, USA. mw@cogit.net
• J Gen Intern Med. 2009 Jun 1; 24 (6): 710-5.

BackgroundFailed referrals for specialty care are common and often represent medical errors. Technological structures and processes account for many failures. Scheduling appointments for subspecialty evaluation is a first step in outpatient referral and consultation.ObjectiveWe determined whether moving from paper-based referrals to a Web-based system with automated tracking features was associated with greater scheduling of appointments among referred patients.DesignStaggered implementation of a quality-improvement project, with comparison of intervention and control groups.ParticipantsPatients 21 or more years of age referred from any of 11 primary-care clinics to any of 25 specialty clinics.InterventionsFaxed referrals were replaced by a Web-based application shared by generalists and specialists, with enhanced communications and automated notification to the specialty office.MeasurementsWe compared scheduling before and after implementation and time from referral to appointment. A logistic regression analysis adjusted for demographics.Main ResultsAmong 40,487 referrals, 54% led to scheduled specialty visits before intervention, compared to 83% with intervention. The median time to appointment was 168 days without intervention and 78 days with intervention. Scheduling increased more when duplicate referrals were not generated (54% for single orders, 24% for multiple orders). After adjustment, referrals with the intervention were more than twice as likely to have scheduled visits.ConclusionsWith a new Web-based referrals system, referrals were more than twice as likely to lead to a scheduled visit. This system improves access to specialty medical services.

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