A structured physician triage program for interventional gastroenterology referrals resulted in a change to the requested clinical management plan in nearly one-quarter of cases, underscoring a significant mismatch between what referring providers ordered and what subspecialists deemed appropriate, according to findings presented at Digestive Disease Week® (DDW) 2026.
“Patient access to GI specialists for procedures and consultation is challenging because of high demands for our services and limited numbers of providers,” said Thomas Savides, MD, of the University of California San Diego, who presented the study. “Triaging of GI referrals is one way we try to make sure the right patient gets to the right care with the right provider at the right time.”
Demand for advanced interventional GI procedures — including endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) — routinely outpaces availability, creating a scheduling and capacity challenge with real consequences for patients.
To address this, Savides and colleagues at an academic medical center with seven interventional GI endoscopists implemented a shared weekly triage rotation, supported by an electronic medical record smart phrase designed to systematically capture and track triage decisions.
The team retrospectively reviewed prospectively collected triage data from March 2024 to March 2025, analyzing a random sample of at least 30 triages per physician from a total of 3,009 triages performed using the structured form. Of the 307 referrals analyzed, 216 (70%) had been requested as direct procedures and 91 (30%) as clinic consultations. Referrals originated predominantly from other GI physicians (35%), primary care providers (25%), and medical or surgical oncology (20%).
Triage review changed the requested clinical management in 74 cases, 24% of the total. “We were surprised to find that triaging changed 1 in 4 of the referrals from the original request,” Dr. Savides said. The most common shifts ran in both directions. Clinic visit referrals were converted to direct procedures in 8% of cases, and direct procedure referrals were downgraded to clinic visits in another 8%. An additional 5% of referrals were redirected entirely to surgical services, requiring neither a GI consult nor a GI procedure. “Especially important was that we prevented some patients from getting potentially risky procedures, and conversely found many patients referred for clinic visits who needed urgent procedures,” he added.
The most frequently performed interventional procedures following triage were combined upper endoscopy and endoscopic ultrasound (EGD-EUS, 48%), colonoscopy (14%), ERCP (12%), and upper endoscopy alone (EGD, 8%).
Perhaps the most striking finding involved urgency designations. Nearly half of all incoming referrals (47%) were labeled urgent or STAT by the referring provider. After physician triage review, only 23% were deemed to need care within two weeks (7% within one week, 16% within two weeks). Another 29% were classified as urgent within four weeks, and 48% were designated routine or within eight weeks.
The authors concluded that interventional GI triage by a subspecialist optimized both patient care and resource utilization. However, Savides noted that the model comes with a significant cost. “The challenge with triage is that it takes a tremendous amount of physician effort, and at least for our group, nearly half of the physician triaging occurred nights and weekends,” he said. “This can lead to physician fatigue and burnout and also has financial implications in terms of compensation for this work.”
Looking ahead, Savides sees a role for technology in easing that burden. “AI triaging will likely help in the future, although some physician triaging will always be needed as every patient is unique,” he said.
Dr. Savides reported no relevant disclosures.
DDW is AGA's annual meeting, jointly sponsored by AGA, AASLD, ASGE, and SSAT. Learn more at ddw.org.