Case Study

How Penn Medicine centralized its fragmented spine referral process

15 Minute Read

Overview

The challenge

Lack of multidisciplinary triage led to poor access and care variation for spine patients at Penn Medicine. Penn’s electronic health record (EHR) system had six spine-related consult orders but offered no guidance on which of the four specialties involved in spine care best suited patients’ needs. This fragmented referral process confused referring providers and barred patients from receiving timely, clinically appropriate appointments. Many needed to be re-referred to other specialties after their initial consult, which lengthened wait times to treatment and worsened the patient experience.

The organization

Penn Medicine is an academic health system headquartered in Philadelphia, Pennsylvania. The Penn Spine Center is staffed by 55 employed providers across four departments and operates at 6 hospitals and 14 multispecialty clinics.

The approach

Penn centralized the internal referral and triage process across its spine network. The newly created spine access team serves as a single entry point and triage mechanism for specialty spine care referrals from internal physicians and select external practices.

The result

Since launching the spine access team in 2018, the percentage of spine patients seen in less than 10 days has risen from 39% to 66%. Penn has also seen double-digit growth in appointment volume across all four departments.

 

Approach

How Penn Medicine consolidated its fragmented referral process

Penn centralized its fragmented referral process by creating a single channel for intaking and triaging internal physicians’ referrals: the multidisciplinary spine access team. The team worked with Penn’s physicians and advanced practice providers to design its protocols, securing their buy-in for the new system.

 

The three elements that drove Penn’s success

Penn successfully built its spine access team by taking the following three steps:

  • Step

    Create a single Epic consult order for internal spine referrals

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  • Step

    Implement multidisciplinary triage with physician input

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  • Step

    Phase program rollout to maintain focus on access and quality

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Results

Since it launched in 2018, the spine access team has achieved its goal of helping patients “get to the right spine provider, for the right type of spine care, within the right time frame.” And it has grown spine referrals in the process.

  • Faster access: 76% of patients are scheduled within 48 hours of a referral being placed. The percentage of patients seen by a specialist within 10 days has risen from 39% to 66% since the program launched.
  • More clinically appropriate referrals: 83% of referrals to the spine access team request a non-operative evaluation.
  • Increased referrals across specialties: Referrals increased by 45% in the program’s first year—despite lower volume overall due to Covid-19. The number of physicians using the new consult order has risen by 48%, and Penn has received 1,294 self-referrals through its website. And despite the program’s high percentage of non-operative consult orders, all four specialties—including orthopedic surgery and neurosurgery—have seen double-digit growth.
Change in spine appointment volume, by specialty

The spine access center has been well received by physicians and executives alike. Penn Medicine next aims to use the program’s success as a launchpad for similar initiatives like optimizing care coordination, further improving access, and capturing other complex specialty conditions.

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