Date of Doctor of Nursing Practice Project Completion

5-2025

Faculty Advisor

Rashmi P. Momin

Abstract

Improving Scheduling Accuracy through a Standardized Dermatology Consult Order

PURPOSE

This quality improvement (QI) project aimed to improve scheduling accuracy and reduce referral errors in a dermatology department by implementing a standardized consult order form within the electronic health record (EHR).

BACKGROUND

Inaccurate dermatology referrals led to misdirected consultations, increased reconsultation rates, and treatment delays. A lack of standardization contributed to inefficiencies, impacting patient outcomes and workflow. Implementing a structured referral form aimed to enhance triaging accuracy and improve timely dermatologic care.

METHODOLOGY

A pre- and post-intervention design was used. An eight-week baseline data collection period (n=288) assessed existing referral errors. The intervention replaced the free-text consult order with a standardized form featuring quick buttons for referral reasons and mandatory clinical fields. An eight-week post-intervention evaluation (n=301) followed. Data were extracted from EHR reports and validated. Minor staff resistance and workflow adaptation challenges were addressed through training and real-time feedback.

RESULTS

Reconsultation rates decreased from 6% to 4% (33% reduction), with external reconsults declining by 37.5%. Clinicians reported improved efficiency and scheduling accuracy, while staff feedback indicated enhanced referral clarity. These improvements are expected to be sustained with continued staff adherence and periodic workflow assessments.

IMPLICATIONS

The structured consult order improved referral accuracy and efficiency and can serve as a model for other specialties. However, variability in provider adoption may impact broader implementation. Future efforts should refine triage protocols and address department-specific challenges to enhance scalability and long-term impact.

Keywords

Consult, Order, Scheduling, Accuracy, Dermatology, Referral, Standardized consult, Electronic health record

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