Using RN Referral Triage to Increase Efficiency of Cardiology Referrals

Description: Appropriately timed access to medical specialist care for evaluation and non-emergent procedures is critical in achieving better health outcomes and reduced health care costs for patients. Delays in care access for patients with chronic illnesses may be managed, in part, by interventions focused on increasing the efficiency and effectiveness of referral to specialty care. Our heart and lung clinic accepts referrals of adults with cardiac disease from across four states. Our clinic includes general cardiology and nine cardiology sub-specialties.
Purpose: To evaluate the intervention of registered nurse-led triage to increase the effectiveness and efficiency of referrals to the cardiovascular institute.
Methods: We used the plan-do-study-act (PDSA) cycle to plan and evaluate this IRB-approved project. The intervention used registered nurses to provide triage of patients referred for cardiology appointments instead of the previous appointment system of first-come, first-served. The pre-intervention time period was September 2022 to February 2023; T1). The post-intervention time periods were March 2023 to August 2023 (T2) and September 2023 to February 2024 (T3). Data from the 6-month pre-intervention period was compared to the subsequent two 6-month post-intervention periods (18 months total) for the total number of referrals per month and length of wait time associated with adult cardiology referrals with GOAL for the length of time from referral to clinic appointment of 7 days. All data were accessed via de-identified EPIC electronic medical record (EHR) reports.
Outcomes: Total volume: An average of 557/month were made in the T1 period. Post-intervention, an average of 683 referrals/month were made in T2 and 698/month were made in T3. A mean of 297 patients/month were seen in pre-intervention period. A mean of 484 patients/month were seen in the first 6 months post-intervention, an average of 491 patients/month were seen in the second 6-month period, and an average of 591 patients/month were seen in the third 6-month period post-intervention. Length of wait time: During the 6-month pre-intervention period, about 7% of newly referred patients were seen within 7 days of their referral. During the third 6-month post-intervention period, a mean of 17.7% of patients were seen within 7 days of their referral.
Evaluation: By 18-months post-intervention, we see 2.5 times as many patients with nurse triage compared to the pre-intervention period. Registered nurse triage has increased the effectiveness and efficiency of referrals to the cardiovascular institute. However, even with nurse triage, we are limited by inadequate numbers of specialized cardiac physicians compared with patient need.