Introduction: Patients discharged from the emergency department (ED) requiring outpatient follow-up are at risk for increased rates of adverse events, return visits to the ED, and hospitalization when they do not follow-up. This highlights preliminary results from a pilot GI Transitionof- Care (GI TOC) program. Methods: A retrospective single center cohort study was performed. ED patients referred for outpatient GI follow-up were examined from before and after implementation of the GI TOC program. The GI TOC program at Stony Brook University Hospital (initiated July 2019) involved a message generated by ED referral orders to GI clinic. This message pool was reviewed by a Gastroenterologist who triaged each patient for urgency and directed patients to appropriate GI subspecialty clinics. The GI office then called patients to facilitate appointment scheduling. Patients discharged from the ED prior GI TOC were simply given the GI office phone number. Primary outcome: percentage of patients discharged from the ED for GI follow-up who successfully completed a follow-up GI appointment. Secondary outcomes included rates of appointment scheduling and percent of diagnostic testing and therapeutic GI procedures generated as a result. Results: There were 233 GI TOC patients during the 5-month period from August-December 2020. 942 ED patients were referred to GI over a 5-month period from February-June 2019. These time periods were chosen to minimize the bias introduced by the COVID19 pandemic. GI TOC patients were statistically more likely to schedule GI appointments (48.93% vs 21.97%, p<0.01) and show up (37.77% vs 20.91%, p<0.01) when compared to pre-GI TOC patients. Of the patients who showed up to appointments, pre-GI TOC patients were more likely to have additional diagnostic testing (e.g. labs and imaging) when compared to GI TOC patients (80.71% vs 64.77%, p<0.01). However, GI TOC patients had a higher percentage of endoscopic procedures ordered when compared to pre-GI TOC patients (85.96% vs 64.41%, p<0.01). Conclusion: Patient navigation through a GI TOC program can result in improved outpatient GI follow-up. Expediting patient care, GI TOC programs can decrease repeat ED visits and costly hospitalizations. GI provider review of consults for urgency and appropriate subspecialty clinics can introduce increased efficiency in patient care. GI TOC can also result in increased downstream revenue for the GI practice through procedure generation..
Implementation of an electronic medical record based transition of care program from the emergency room to gastroenterology clinics improves followup