Table 2

Current use and identified opportunities to apply reliability design principles to improve closing loops in diagnostic referrals

Reliability construct (ordered from high to low)Current processAdditional opportunities
Forcing functions
  • Referral guidelines displayed in EHR before order can be placed.

  • Standardising scheduling process across all specialties/departments.

Process Automation (and IT)
  • Centre for Clinical Computing scheduling system

  • Standardised note templates

  • Patient portal

  • Urgency indicators on orders to create priority lists.

  • Standardised electronic order forms across specialties.

  • Centralised retrieval of orders for specialties.

  • Self-scheduling platform for patients.

  • Improved messages tab within EHR to declutter and prioritise critical referrals.

  • Automated performance measurement and reporting.

Redundancy, inspection
  • Staff verifying insurance will approve referral after order is placed.

  • Multiple attempts to contact patients to schedule.

  • Specialists verifying/correcting provider-indicated urgency for referral.

  • Confirming patient preference of contact method at point of order of referral.

  • Tracking patient contact attempts and displaying in a streamlined manner.

Reminders, checklists
  • Referral list manager.

  • Providers writing Post-It notes to follow up on certain patients.

  • Providers adding follow-up reminders to their to-do list within the EHR.

  • Call/text reminders for patients to schedule and confirm appointment.

  • Time-based triggers/reminders for providers to follow up on critical not scheduled or kept referrals.

Education, awareness
  • Patients educated at visit about following up on test or referral.

  • Patient self-advocacy.

  • Clinical decision support and guidelines for referrals at point of order.

  • Strengthened patient understanding of clinical importance of referral.

  • Patient indication of needing support to close loop on referral.

  • EHR, electronic health record.