JMIR Publications

ABSTRACT

Given rising demand for Emergency Department (ED) services and coupled with a scarcity of specialty care availability, there is urgency to design a system for appropriate, effective, and timely ED-to-specialty outpatient referrals. Efficient care transitions are important to patient outcomes and experience and require cross-specialty cooperation. Here we describe a collaboration between Stanford’s Emergency Medicine and Neurology & Neurological Sciences departments that designed and implemented an optimized discharge process and transition of care from ED to ambulatory neurology for follow-up care. We describe the process for barrier identification, tools used to foster partnership and intervention ideation, and the resulting intervention. Our experience and findings are integrated into a 4-component framework for future interdepartmental collaborations: (1) cross-specialty team meetings; (2) pre-implementation interviews; (3) a design thinking focus group session; and (4) small group meetings. These process components fostered collaboration and teamwork amongst the multi-disciplinary team; supported early identification of barriers and facilitators, including divergent understanding of project goals; and developed creative ideas that contributed to intervention development. The collaboration resulted in a 4-pronged multi-modal intervention. Two elements focused on modifying clinical practice to better triage clinically appropriate ED referrals to ambulatory neurology: (1) optimizing management of conditions in the ED to reduce preventable referrals, and (2) increasing deferral to Primary Care clinicians to direct appropriate specialty follow-up care. Two additional structural elements sought to directly improve appropriate referral timeliness by: (3) streamlining insurance authorization processes and (4) increasing neurology appointment availability.