To evaluate the current outpatient scheduling process for urgent neurology referrals in order to reduce wait times at a large academic center.

Long wait times for time-sensitive outpatient neurology referrals delay time to diagnosis and increase emergency room visits. At our academic health center, internal referring physicians use an electronic health record order to request outpatient neurology appointments. This order includes a priority checkbox (“urgent” vs “routine”), but does not require additional information about referral reason. Non-clinical schedulers then rely on referrer-deemed urgency to prioritize new patient visits without neurologist review.

For this quality improvement initiative, retrospective chart review was performed on 150 patients to assess referrer judgment of neurologic urgency. Using referral management software, new patient appointment wait times were tracked for eight months in 2021. Based on these data, metrics of neurologic urgency were created.

Definitions of neurologic urgency vary between neurologists and referrers. Referrer judgment of urgency was found to be 41% sensitive and 64% specific. Wait times for referrals marked “routine” averaged 34 days, whereas wait times for neurologist-deemed urgent patients averaged 35 days. Based on our retrospective study, we identified 5 main predictors of time-sensitive outpatient neurology referrals: new persistent sensory loss or weakness; immunosuppression or being treated for cancer; abnormal brain or spine imaging; currently pregnant; new or recurrent loss of consciousness or seizure-like episodes.

Relying on referrer urgency designation is a poor way to triage neurologic urgency of referrals. This leads to long wait times for time-sensitive neurologic conditions. Specific questions can be used to define urgency rather than an urgency check box. We plan to implement these questions in our EHR referral system and trend impact on wait times, number of urgent referrals, and specificity of these questions to predict neurologic urgency.