Does a Centralized Scheduling Process Improve Referral Timeliness?

Background: Timely, necessary specialist care is associated with better patient health outcomes and lower costs. This assessment looks at the effects of centralized scheduling, as well as patient and referral-level factors on referral completion rates. We hypothesized that centralized scheduling would increase access to specialty care, as evidenced by higher referral completion rates.

Methods: We analyzed data for specialty referrals to cardiology, nephrology, gastroenterology, and neurology from 6 months before to 6 months after implementation of a centralized scheduling system within a midwestern academic health system. We considered a referral complete if an appointment occurred within 3 months following an order for service.

Results: Overall, referral completion rates modestly increased (63.7% to 69.9%,  < 0.01), but this was driven by improvement within a single specialty (gastroenterology, 54.2% to 67.3%,  < 0.05). Other specialties saw either no significant change (neurology, nephrology) or a decrease (cardiology, 87.3% to 78.6%,  < 0.05). The time to schedule, or cycle time, improved overall from 21 days (SD 8-38) to 15 days (SD 8-30),  <0.05.

Conclusions: Centralized scheduling had inconsistent effects on referral completion across specialties, though the process (cycle time) improved. Variable implementation fidelity and microenvironments likely contributed to uneven findings across specialties. Centralized scheduling may improve timely access but likely depends on implementation and buy-in.