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<p>Timely evaluation of skin lesions suspicious for skin cancer is essential to prevent delayed diagnoses and poor outcomes. However, ensuring completion of dermatology referrals, known as loop closure, remains a persistent challenge in primary care. In February 2022, a multi-component intervention was implemented at our institution within the electronic health record (EHR), consisting of a revised consult form requiring urgency designation and a referral list manager to support real-time tracking, scheduling, and outreach. This study evaluates the impact of that intervention on referral outcomes. We conducted a retrospective cohort study of 798 urgent dermatology referrals for lesions suspicious for skin cancer across four time periods: January 1 to December 31, 2018 (pre-pandemic, <i>n</i> = 324), March 1, 2020 to February 28, 2021 (intra-pandemic, <i>n</i> = 174), February 1 to July 31, 2022 (early implementation, <i>n</i> = 176), and February 1 to July 31, 2023 (full implementation, <i>n</i> = 124). Loop closure was defined as completion of the dermatology visit within 365 days, and timely closure as within 30 days. Timely loop closure improved during the full implementation period (63.7%) compared to the pre-pandemic (50.3%), intra-pandemic (48.3%), and early implementation (47.7%) periods (<i>p</i> &lt; 0.05). Mean time to closure declined from 75.2 days pre-pandemic to 40.5 days during full implementation (<i>p</i> = 0.014). In multivariable analysis, referrals during full implementation had lower odds of delayed or non-completion versus the pre-pandemic period (odds ratio [OR] = 0.63, 95% confidence interval [CI] = 0.40–0.99, <i>p</i> = 0.046). Black race (OR = 1.79, 95% CI = 1.12–2.87, <i>p</i> = 0.016) and primary language other than English or Spanish (OR = 2.29, 95% CI = 1.07–4.91, <i>p</i> = 0.033) were associated with ~ 83–130% increased odds of delayed or non-completion. An EHR-based referral workflow intervention incorporating a structured consult form, centralized tracking, and outreach infrastructure was associated with improved timeliness and reliability of urgent dermatology referrals. Continued efforts are needed to evaluate this intervention in other settings, address persistent disparities, and ensure equitable access to specialty care.</p>

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Impact of a new referral workflow on timely completion of urgent dermatology referrals

  • 期刊论文

  • 发表日期：

    2026年6月18日

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  • Emma Beagles,
  • G. Ege Eskibozkurt,
  • Scot B. Sternberg,
  • James C. Benneyan,
  • Gordon D. Schiff,
  • Maelys J. Amat,
  • Leonor Fernández,
  • Talya Salant,
  • Russell Phillips,
  • Mark D. Aronson,
  • Allen F. Shih

摘要

Timely evaluation of skin lesions suspicious for skin cancer is essential to prevent delayed diagnoses and poor outcomes. However, ensuring completion of dermatology referrals, known as loop closure, remains a persistent challenge in primary care. In February 2022, a multi-component intervention was implemented at our institution within the electronic health record (EHR), consisting of a revised consult form requiring urgency designation and a referral list manager to support real-time tracking, scheduling, and outreach. This study evaluates the impact of that intervention on referral outcomes. We conducted a retrospective cohort study of 798 urgent dermatology referrals for lesions suspicious for skin cancer across four time periods: January 1 to December 31, 2018 (pre-pandemic, n = 324), March 1, 2020 to February 28, 2021 (intra-pandemic, n = 174), February 1 to July 31, 2022 (early implementation, n = 176), and February 1 to July 31, 2023 (full implementation, n = 124). Loop closure was defined as completion of the dermatology visit within 365 days, and timely closure as within 30 days. Timely loop closure improved during the full implementation period (63.7%) compared to the pre-pandemic (50.3%), intra-pandemic (48.3%), and early implementation (47.7%) periods (p < 0.05). Mean time to closure declined from 75.2 days pre-pandemic to 40.5 days during full implementation (p = 0.014). In multivariable analysis, referrals during full implementation had lower odds of delayed or non-completion versus the pre-pandemic period (odds ratio [OR] = 0.63, 95% confidence interval [CI] = 0.40–0.99, p = 0.046). Black race (OR = 1.79, 95% CI = 1.12–2.87, p = 0.016) and primary language other than English or Spanish (OR = 2.29, 95% CI = 1.07–4.91, p = 0.033) were associated with ~ 83–130% increased odds of delayed or non-completion. An EHR-based referral workflow intervention incorporating a structured consult form, centralized tracking, and outreach infrastructure was associated with improved timeliness and reliability of urgent dermatology referrals. Continued efforts are needed to evaluate this intervention in other settings, address persistent disparities, and ensure equitable access to specialty care.