The American Diabetes Association and the American College of Physician recommend Hemoglobin A1c testing for all patients preoperatively to identify elevated HbA1c levels in order to intervene, attain glycemic control, and optimize health status. RWJ bariatric program has been successful in achieving preoperative HbA1c testing for 100% of patients. However, we lacked a formal referral process for patients with elevated HbA1c levels. The American Diabetes Association recommends patients’ referral for elevated HbA1c based on patient’s individualized needs.


A task force was developed to establish a formal referral process. The team comprised of bariatric surgeons, endocrinologist, anesthesiologists, clinical reviewers, nursing directors,clinical nurse educators, APNs, and clinical nurses. Charts were reviewed weekly for patients with an HbA1c ≥6.5 from March 2019-June 2019. A gap analysis was done through data collection which included patients with HbA1c greater than 6.5 and medical records were reviewed to determine referral need. The team conducted a process mapping, sought out internal and external referral resources, and developed strategies to gain stakeholder buy-in. As a result of the team’ efforts our formalized referral process is as follows: Pre admission testing reviews all HbA1c test results, those that are greater or equal to 6.5 are reported to Bariatric surgeons’ office. Surgeon provides referral options to the patients based on individualized needs and preferences. Referrals options included the wellness groups, endocrinologist, PCP, nutritionists and support groups.


2019 referral rates:February 69%, March 70%, April 80%, May 93%, June 100%, July 100%.


Through the development of a formal referral process 100% of the pre-surgical bariatric patients with a HbA1c ≥ 6.5 are provided with resources to aid in health status optimization.