Introduction Rapid, reliable and efficient communication in healthcare systems with finite resources promises to improve patient care. Telephone engagement has effectively monopolised the referral process in the acute setting. Hence, traditional inter-hospital referral networks are potentially time consuming, not expeditious and frustrating. There is often no comprehensive documented communication record or audit trail. Social media, however, suggest that instantaneous, secure and dependable exchanges of information can occur via alternative conduits, potentially transforming the acute clinical referral system. The National On-Call Referral System (NORSe) was established in 2010 as an alternative referral paradigm. We explore the literature evidence surrounding the clinical impact of the NORSe referral system and analogous models. Early evidence suggests that NORSe may minimise delays in obtaining specialist advice and management, particularly in the acute setting. It enables the specialist to receive and address a large number of fact intense referrals that would otherwise be unpalatable and unmanageable. We summarise recent developments with the NORSe and give an overview of its clinical applications and links with clinical governance. NORSe and similar models promise to change the way we communicate as doctors, making the process more efficient, with a robust audit trail facilitating service appraisal and training.

Cerebral palsy is a non-progressive damage to the brain and can occurs before, during or after delivery, with musculoskeletal system affected by various degrees [1]. Hip instability and gait abnormalities are common hip problems in Cerebral palsy patients. Hip subluxation and dislocation develops in response to muscle imbalance and spasticity [2]. The patient's problems vary from abnormal gait to painful seating and difficulty in personal hygiene. The goal of treatment in those patients is to provide a painless hip that allows stable sitting and positioning. Incidence The incidence of cerebral palsy is increasing slightly with reports estimating the incidence to be between 2.4 and 2.7 per 1000 live births [3]. The reported incidence of hip displacement in children with cerebral palsy has ranged from 1% to 75% and has been linked with the severity of involvement and the ambulatory status. Incidence of hip displacement is low in patients with mild involvement and who can walk independently, whereas those with more severe involvement and who are unable to walk have the greatest risk of hip displacement [4]. The lowest incidence of hip displacement was found in the children