Presentation Title: Closing the cross-institutional referral loop: Assessment of consultation note quality
Author Name(s): April Savoy, PhD1,3,4, Amee Sangani2, and Michael Weiner, MD, MPH2,3,4
Author Department and School Affiliation: 1Purdue School of Engineering and Technology; 2Indiana University School of Medicine; 3Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center; 4Regenstrief Institute, Inc.
Objective: Poor communication and co-management of comorbidities during the referral process increases physician workload, patient burden, and risks. In this preliminary study, our objective was to understand how consultants’ notes support physician collaboration within and across health care institutions.
Project Methods: We conducted chart reviews. Accessing the Indiana Network for Patient Care database, consultation notes were randomly selected from five specialties within the Indiana University Health network, including internal and external referrals. The Quality of Consult Assessment tool was adapted to assess note quality and co-management facilitation.
Results: We reviewed medical records of ten patients. All consultation notes contained clinical recommendations. Seventy percent of notes referred to explicit consultant responsibilities. Conversely, only one contained explicit responsibilities for referrers. Charts denoted reliance on support staff to send messages among referrers, consultants, and patients via phone and facsimile.
Conclusion: The clinical documentation reviewed supported specialty referrals for transitions of care rather than co-management of care. Accessing medical records across institutions contributed to a lack of clinical context, and workflow inefficiencies, when attempting to co-manage clinical care.