To describe the process and to identify areas for intervention and improvement for patients referred from their primary care physician (PCP) to a safety-net teaching neurology clinic.

Access to specialty care commonly occurs via a referral from PCPs. Placing a referral order may appear simple but processes for review and triage of referrals are complex. As the needs for specialty care increases, it is increasingly important to understand the complete referral process, where there are delays and opportunities for intervention. Electronic Health Records (EHRs) show promise to support these processes. With their ubiquitous use, it is even more important to understand and manage how EHR’s communicate and share data between different medical practices for coordinating patient care.

Referral-level data were collected using the neurology resident clinic referral management software. Spreadsheets of referral status and timestamps of status changes were generated for each referral from 7/1/2019 to 6/30/2020 and descriptive statistics were performed of referrals and time spent in each status. A process flow diagram was created that illustrated the referral process with time spent and percentages of referrals in each status. 

40% of neurology referrals were noted as incomplete and 8% did not meet referral criteria. Referrals noted with either of these statuses did not progress to a neurology visit while communication was sent to the PCP seeking new information or re-referral. 22% of referrals were scheduled for neurology visit and the remaining 30% of referrals were placed into statuses such as “could not contact”, “financial screening”, or “patient refused”.

Nearly half of patients who needed neurologic care did not receive a visit with a neurologist due to gaps in the referral process. We identified multiple opportunities for future work to improve the referral process and have a mechanism for measuring effects of future interventions.