Building a Medical Neighborhood in the Safety Net: An Innovative Technology Improves Hematuria Workups

Abstract

To analyze whether ereferral is associated with decreased time to completion of hematuria workup. We included 100 individuals referred to Olive View-UCLA Medical Center for urologic consultation for hematuria. Half were referred before implementation of ereferral, and half were referred after the system was implemented. We performed bivariate analysis to assess correlations of baseline subject sociodemographic and clinical characteristics with ereferral status. We also created a multivariate linear regression model for log days to completion of hematuria workup, with ereferral as the main predictor and subject sociodemographic and clinical characteristics as covariates. Excluding cases with an infectious cause, the mean number of days from urinalysis documenting hematuria to completed hematuria workup was 404 days before ereferral and 192 days after implementation of ereferral (median 239 vs 170; 2-sample median P = .0013). Upper tract imaging was obtained at a median of 76 days after initial positive urinalysis in the absence of infection, 122 days before ereferral, and 41 days after implementation of ereferral (2-sample median P = .1114). In all cases, lower tract evaluation was completed after upper tract imaging. Our multivariable model evaluating factors associated with time to hematuria workup demonstrated that ereferral use was independently associated with shorter time to hematuria workup (P = .006). Electronic consultations can significantly shorten the time to work-up of hematuria in the safety net.