Improving Referral Follow-Up Using EMR Protocols
Poster #: 104
Session/Time: A
Author:
Anna Yang, BS
Mentor:
Richard M Bikowski, MD
Research Type: Clinical Research
Abstract
INTRODUCTION:
Student-run free clinics often face challenges maintaining continuity of care due to fragmented referral systems and turnover among student volunteers, resulting in missed or incomplete follow-up for patients. At Eastern Virginia Medical School (EVMS), referrals from the Street Health Clinic to the student-run HOPES Free Clinic were historically tracked via emails and manual chart review, resulting in inconsistent follow-up and variability in referral outcomes. Strengthening referral systems is essential to better meet patient needs and can help enhance clinic impact. On January 1, 2025, a standardized student training guide for referrals in the Practice Fusion EMR was implemented. This project evaluated whether this intervention improved referral efficiency, consistency, documentation, and patient follow-up.
METHODS:
This quality improvement (QI) initiative used a pre/post design comparing six months of referral data before (July 1, 2024-January 1, 2025) and after (January 1-July 1, 2025) implementation. The guide included step-by-step EMR referral guide and was paired with in-person training. Pre-implementation referrals were tracked via weekly clinic emails and chart reviews; post-implementation referrals were recorded using the "Referrals" tab in Practice Fusion and cross-referenced with clinic summaries. Outcomes included total referrals, method of referral, and appointment status (completed, no-show, canceled, pending). Monthly data collection is being conducted by the project team using reports from Practice Fusion and clinic emails. These include the "Appointment Report and Eligibility," "Patient List," and "Referrals" tab, along with weekly clinic summary emails to track referrals. Data is stored in the REDCap database. IRB Status: This initiative was determined to be a QI project, not human subjects research. IRB approval was not required (determination letter dated 4/25/2025).
RESULTS:
Three categories were reviewed for the results. First, the clinic the patient was sent to (HOPES Free Clinic, ACC (Ambulatory Care Center), and Ghent Family Medicine). Second, whether an appointment was made for the patient (made vs not made). Third, the status of the appointment (arrived, no-show, cancelled, unknown). In the pre-guide period, six referrals were made - all to HOPES Free Clinic - and all via email. Of these appointments, 2 appointments were completed (arrived), 2 were no-shows, and 2 were never scheduled (not made). In the post-guide period, 24 referrals were made, with 96% (23/24) entered using the Practice Fusion EMR. Referral locations included HOPES (21), ACC (2), Ghent Family Medicine (1). Completed referrals increased from 2 to 5, "not made" appointments stayed the same at 2, "no show" appointments increased from 2 to 12, and "cancelled" appointment increased from 0 to 1.
CONCLUSION:
As anticipated, the post-guide period saw an increase in total referrals and a decrease in the proportion of unmade appointments. However, a rise in the no-show rate emerged, highlighting an important area for future investigation and underscoring ongoing unmet needs within the patient population. The structured referral guide -integrated with EMR functionality and supported by team training- improved referral management in our student-run clinics and streamlined referral tracking. This intervention may serve as a replicable model for strengthening continuity of care in similar settings.
Student-run free clinics often face challenges maintaining continuity of care due to fragmented referral systems and turnover among student volunteers, resulting in missed or incomplete follow-up for patients. At Eastern Virginia Medical School (EVMS), referrals from the Street Health Clinic to the student-run HOPES Free Clinic were historically tracked via emails and manual chart review, resulting in inconsistent follow-up and variability in referral outcomes. Strengthening referral systems is essential to better meet patient needs and can help enhance clinic impact. On January 1, 2025, a standardized student training guide for referrals in the Practice Fusion EMR was implemented. This project evaluated whether this intervention improved referral efficiency, consistency, documentation, and patient follow-up.
METHODS:
This quality improvement (QI) initiative used a pre/post design comparing six months of referral data before (July 1, 2024-January 1, 2025) and after (January 1-July 1, 2025) implementation. The guide included step-by-step EMR referral guide and was paired with in-person training. Pre-implementation referrals were tracked via weekly clinic emails and chart reviews; post-implementation referrals were recorded using the "Referrals" tab in Practice Fusion and cross-referenced with clinic summaries. Outcomes included total referrals, method of referral, and appointment status (completed, no-show, canceled, pending). Monthly data collection is being conducted by the project team using reports from Practice Fusion and clinic emails. These include the "Appointment Report and Eligibility," "Patient List," and "Referrals" tab, along with weekly clinic summary emails to track referrals. Data is stored in the REDCap database. IRB Status: This initiative was determined to be a QI project, not human subjects research. IRB approval was not required (determination letter dated 4/25/2025).
RESULTS:
Three categories were reviewed for the results. First, the clinic the patient was sent to (HOPES Free Clinic, ACC (Ambulatory Care Center), and Ghent Family Medicine). Second, whether an appointment was made for the patient (made vs not made). Third, the status of the appointment (arrived, no-show, cancelled, unknown). In the pre-guide period, six referrals were made - all to HOPES Free Clinic - and all via email. Of these appointments, 2 appointments were completed (arrived), 2 were no-shows, and 2 were never scheduled (not made). In the post-guide period, 24 referrals were made, with 96% (23/24) entered using the Practice Fusion EMR. Referral locations included HOPES (21), ACC (2), Ghent Family Medicine (1). Completed referrals increased from 2 to 5, "not made" appointments stayed the same at 2, "no show" appointments increased from 2 to 12, and "cancelled" appointment increased from 0 to 1.
CONCLUSION:
As anticipated, the post-guide period saw an increase in total referrals and a decrease in the proportion of unmade appointments. However, a rise in the no-show rate emerged, highlighting an important area for future investigation and underscoring ongoing unmet needs within the patient population. The structured referral guide -integrated with EMR functionality and supported by team training- improved referral management in our student-run clinics and streamlined referral tracking. This intervention may serve as a replicable model for strengthening continuity of care in similar settings.