Staff Experiences With Implementation of the Referral Coordination Initiative.

Area of Science:

• Healthcare Management
• Clinical Operations
• Patient Referral Systems

Background:

• The Referral Coordination Initiative (RCI) aims to enhance specialty care referrals within the VHA.
• It employs a team-based strategy, shifting triage tasks from specialists to nurses to improve timeliness and patient-centeredness.

Purpose of the Study:

• To evaluate VHA staff experiences with the nationwide dissemination of the Referral Coordination Initiative (RCI).
• To identify challenges and facilitators impacting RCI implementation and maintenance.

Main Methods:

• Qualitative interviews were conducted with 68 VHA staff members across four sites and three high-volume specialties.
• Participants included nurses, schedulers, specialists, and referring providers.
• Data analysis used a rapid matrix approach, concurrent with data collection.

Main Results:

• Staff reported diverse perceptions of RCI's impact on specialist workload and staffing.
• Identified challenges include inconsistent program goal understanding, mixed views on nurse triage, lack of specific triage guidelines, and poor scheduler coordination.
• Facilitators involved utilizing existing relationships, nurses with specialty expertise, and developing clear guidelines.

Conclusions:

• Fostering collaboration between referral teams and specialties is crucial for patient-centered referrals.
• Nurse-led triage shows potential for efficiency but requires dedicated training and clear criteria development.