A Brief, Low-cost Intervention Improves the Quality of Ambulatory Gastroenterology Consultation Notes

Abstract

Background Effective communication between primary care providers and specialty providers is important to facilitate high-quality specialty care. Few studies have assessed the quality of communication from specialist to primary care providers or implemented interventions to improve quality. We developed a brief, low-cost intervention designed to improve the quality of ambulatory gastroenterology consultation notes written by fellows and nurse practitioners in our urban healthcare system. Methods Six physicians (3 specialists and 3 primary care providers) scored pre- and post-intervention notes using an objective quality assessment instrument that had excellent inter-rater reliability. They were blinded to note date, author, and pre/post-intervention status. The primary outcome was improvement in Composite Quality Score, an objective, comprehensive assessment of quality. Secondary outcomes included improvements in three specific domains, and Global Quality Score (a subjective measure of quality). Results 200 pre- and 200 post-intervention notes written by 4 fellows and 2 nurse practitioners were included. Composite Quality Score improved from 3.74 (out of 5) to 4.09 (P<0.001 in adjusted analysis). All secondary outcomes improved in adjusted analyses as well. The largest increase was seen in Communication Domain (22% increase). Fellow-written notes had higher scores than nurse practitioner-written notes, but nurse practitioner-written notes improved to a greater degree. Conclusion A brief, low-cost intervention significantly improved the quality of ambulatory gastroenterology consultation notes written by fellows and nurse practitioners. Communication between primary care providers and specialists is an important area for further study.

Efficiency Gains for Rheumatology Consultation Using a Novel Electronic Referral System in a Safety‐Net Health Setting

“…In addition, there was rapid care communication from the specialist to the primary care provider, with an average rheumatologist response time ranging 1-4 days. Corroborating our findings in rheumatology, eReferral has been found effective in streamlining the referral process in other specialties (3,5,8,12). In addition, our data support the findings in 2 earlier studies done in rheumatology, demonstrating that use of nonelectronic preappointment management can increase access to rheumatologists (6,7).…”

Gastroenterologist and primary care perspectives on a post-endoscopy discharge policy: impact on clinic wait times, provider satisfaction and provider workload

“…For example, an integrated electronic consultation and referral program was introduced in 2005 for gastroenterology, allowing referring clinicians and specialists to communicate electronically to ensure appropriate triage and pre-consultation workup [ 12 ] for patients requiring gastroenterology. And in 2012, an intervention was developed to improve the quality of gastroenterology consultation notes [ 14 ]. These interventions may have also contributed to improved access to SFHN gastroenterology services, but did not likely have a large impact on wait times for new patient appointments.…”

Completeness and quality of text paging for subspecialty consult requests

“…A prior study of consult note quality showed a global quality score (1-5 scale) correlated well with objective measures of note quality. 11 Thus, we used a subjective assessment by three raters (one practising hospital medicine, two practising nephrology). Because objective measures of text page quality are not established, we intentionally did not create a rubric, as doing so would assume certain features correlated with quality.…”