Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Research article

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

Authors: Daniel Selvig, Justin L. Sewell, Delphine S. Tuot, Lukejohn W. Day

Published in: BMC Health Services Research | Issue 1/2018

Login to get access

Abstract

Background

To reduce unnecessary ambulatory gastroenterology (GI) visits and increase access to GI care, San Francisco Health Network gastroenterologists and primary care providers implemented guidelines in 2013 that discharged certain patients back to primary care after endoscopy with formal written recommendations. This study assesses the longer-term impact of this policy on GI clinic access, workflow, and provider satisfaction.

Methods

An email-based survey assessed gastroenterologist and primary care provider (PCP) opinions about the discharge process. Administrative data and chart review were used to assess clinic access, intervention fidelity, and re-referral rates.

Results

102/299 (34%) of PCPs and 5/7 (71%) of gastroenterologists responded to the survey. 74% of PCPs and 100% of gastroenterologists were satisfied or very satisfied with the discharge process. 80% of gastroenterologists believed the discharge process decreased their workload, while 53.5% of primary care providers believed it increased their workload. 6.7% of patients discharged to primary care in 2013 had re-referrals to GI. Wait time for the third-next-available new outpatient GI clinic appointment had previously decreased from 158 days (2012, pre-intervention) to 74 days (2013, post-intervention). In 2015, wait time was 19 days (p < 0.001 for 2012 vs. 2015).

Conclusions

Primary care providers and gastroenterologists are satisfied with an intervention to discharge patients from gastroenterology to primary care after certain endoscopic procedures, although this conclusion is limited by a relatively low PCP survey response rate. Discharging appropriate patients using consensus criteria from the gastroenterology clinic was instrumental in sustainably reducing clinic wait times with low re-referral rates.
Appendix
Available only for authorised users
Literature
1.
2.
3.
Reeve H, Baxter K, Newton P, Burkey Y, Black M, Roland M. Long-term follow-up in outpatient clinics: 1: the view from general practice. Fam Pract. 1997;14(1):24–8.CrossRefPubMed
4.
Turner AM, Dalay SK, Talwar A, Snelson C, Mukherjee R. Reforming respiratory outpatient services: a before-and-after observational study assessing the impact of a quality improvement project applying British Thoracic Society criteria to the discharge of patients to primary care. Prim Care Respir J. 2013;22(1):72–8.CrossRefPubMed
5.
Watters GW, Milford CA. Outcome following discharge from an ENT out-patient clinic: patient and general practitioner satisfaction. Clin Otolaryngol Allied Sci. 1994;19(6):505–8.CrossRefPubMed
6.
Valderas JM, Starfield B, Forrest CB, Sibbald B, Roland M. Ambulatory care provided by office-based specialists in the United States. Ann Fam Med. 2009;7(2):104–11.CrossRefPubMedPubMedCentral
7.
Ackerman SL, Gleason N, Monacelli J, Collado D, Wang M, Ho C, Catschegn-Pfab S, Gonzales R. When to repatriate? Clinicians’ perspectives on the transfer of patient management from specialty to primary care. J Gen Intern Med. 2014;29(10):1355–61.CrossRefPubMedPubMedCentral
8.
Tuot DS, Sewell JL, Day L, Leeds K, Chen AH. Increasing access to specialty care: patient discharges from a gastroenterology clinic. Am J Manag Care. 2014;20(10):812–9.PubMed
9.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.CrossRefPubMed
10.
Brez S, Rowan M, Malcolm J, Izzi S, Maranger J, Liddy C, Keely E, Ooi TC. Transition from specialist to primary diabetes care: a qualitative study of perspectives of primary care physicians. BMC Fam Pract. 2009;10:39.CrossRefPubMedPubMedCentral
11.
Day LW, Bhuket T, Inadomi JM, Yee HF. Diversity of endoscopy center operations and practice variation across California’s safety-net hospital system: a statewide survey. BMC Res Notes. 2013;6:233.CrossRefPubMedPubMedCentral
12.
Chen AH, Murphy EJ, Yee HF Jr. eReferral – a new model for integrated care. N Engl J Med. 2013;368(26):2450–3.CrossRefPubMed
13.
Pham HH, O’Malley AS, Bach PB, Saiontz-Martinez C, Schrag D. Primary care physicians’ links to other physicians through Medicare patients: the scope of care coordination. Ann Intern Med. 2009;150(4):235–42.CrossRef
14.
Sewell JL, Day LW, Tuot DS, Alvarez R, Yu A, Chen AH. A brief, low-cost intervention improves the quality of ambulatory gastroenterology consultation notes. Am J Med. 2013;126(8):732–8.CrossRefPubMedPubMedCentral
Metadata
Title
Gastroenterologist and primary care perspectives on a post-endoscopy discharge policy: impact on clinic wait times, provider satisfaction and provider workload
Authors
Daniel Selvig
Justin L. Sewell
Delphine S. Tuot
Lukejohn W. Day
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-017-2819-6

Other articles of this Issue 1/2018

BMC Health Services Research 1/2018 Go to the issue

Research article

Developing a comorbidity index for comparing cancer outcomes in Aboriginal and non-Aboriginal Australians

Research article

Relational autonomy in breast diseases care: a qualitative study of contextual and social conditions of patients’ capacity for decision-making

Research article

Patient satisfaction, patients leaving hospital against medical advice and mortality in Italian university hospitals: a cross-sectional analysis

Research article

Long-term effects of cancer on earnings of childhood, adolescent and young adult cancer survivors – a population-based study from British Columbia, Canada

Study protocol

A municipality-based vocational rehabilitation programme for occupationally marginalized citizens: a study protocol for a mixed methods study

Research article

Access to assistive technology in two Southern African countries