763 - Who gets a Fast Pass? A Quality Improvement Journey for Urgent Referrals to Behavioral Health Services from Pediatric Primary Care

Publication Number: 763.7008

Amanda Gogol-Tagliaferro, Akron Children's Hospital, Brecksville, OH, United States; Rihab I. Mohamed, Akron Children's Hospital, Akron, OH, United States; Marti Dudones, Akron Children's Hospital, Akron, OH, United States; Nicole Colbetzor, Akron Children's Hospital, Norton, OH, United States

Background: Behavioral Health Services at Akron Children’s Hospital experiences a high volume of weekly referrals, particularly from our extensive primary care network of over 44 offices. This trend highlights the ongoing mental health crisis affecting children and adolescents in the United States. Our referral system enables managing providers to designate referrals as “urgent,” prioritizing patients who are at the highest risk of self-harm.

Objective: We aimed to enhance access to mental health services for patients with urgent needs by improving the accuracy of urgent referrals to Behavioral Health. Current criteria include a PHQ-9 score over 20 and/or suicidality concerns as indicated by the Columbia-Suicide Severity Rating Scale (C-SSRS). Patients meeting these criteria receive timely access to a behavioral health provider within 2 to 4 weeks. We sought to improve referral accuracy through provider education and revisions to Our Practice Advisories (OPA) in the electronic medical record.

Design/Methods: • Utilized a weekly urgent referral report to review the accuracy of all referrals placed from primary care.
• Provided targeted provider education through various channels to enhance awareness of urgent referral criteria.
• Modified Our-Practice-Advisories (OPAs) in the electronic health record to clearly communicate recommendations for managing patients with mental health concerns.

Results: • The objective of improving the overall accuracy of urgent referrals was not achieved.
• Total urgent referrals decreased.
• The percentage of patients seen within the urgent referral time frame improved.

Conclusion(s): Provider education, including OPA advisories in electronic medical records, did not significantly improve the accuracy of urgent behavioral health referrals. Future efforts will focus on implementing informatics-based solutions with embedded clinical decision support to enhance referral accuracy.

We will also expand referral criteria for pediatric patients to address needs beyond suicidality and severe depression. The initial integration of behavioral health services in our 44 primary care offices may have reduced overall urgent referrals and improved access to mental health services. We will investigate this trend over time to understand the factors contributing to enhanced access, particularly for urgent referrals.

% of Urgent Referrals to Behavioral Health seen within urgent timeframe
There is an improvement in the overall patients marked as having an "urgent" referral seen within the urgent timeframe.

Monthly Urgent Referrals and Intervention Efforts
This is a p-chart depicting the total number of monthly "urgent" referrals and the accuracy of those referrals meeting "urgent" criteria. We did not see a center line shift but did see an overall decrease in the number of urgent referrals.

% of Urgent Referrals to Behavioral Health seen within urgent timeframe
There is an improvement in the overall patients marked as having an "urgent" referral seen within the urgent timeframe.

Monthly Urgent Referrals and Intervention Efforts
This is a p-chart depicting the total number of monthly "urgent" referrals and the accuracy of those referrals meeting "urgent" criteria. We did not see a center line shift but did see an overall decrease in the number of urgent referrals.