Clinical guidelines as decision support for referrals from primary care

Heimly, Vigdis; Nytrø, Øystein

doi:10.1109/iri.2011.6009582

Cited by 6 publications

(4 citation statements)

References 23 publications

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“…This observation may support the hypothesis, enabling an automated referral system may improve the communication gap, and reduce waiting time between the primary health center and the referred hospitals [ 6 ]. The evidence-based point-of-care instrument can thus be suggested that assist the process of filling out a referral template to reduce time and error [ 11 ] and helps to assist the referral follow-up [ 38 ]. However, further investigation is required to explore the barriers and facilitators for enhancing the quality of referral service and to deliver a fully functional and effective referral system.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of low resource setting referral pathways to improve coordination and evidence-based services for maternal and child health in Ethiopia

et al. 2022

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Background In low-resource settings, patient referral to a hospital is an essential part of the primary health care system. However, there is a paucity of study to explore the challenges and quality of referral coordination and communication. Objective The purpose of this research was to analyze the existing paper-based referral registration logbook for maternal and child health in general and women of reproductive age in particular, to improve referral coordination and evidence-based services in Low-Resource Settings. Methods This study analyzed the existing paper-based referral registration logbook (RRL) and card-sheet to explore the documentation of the referral management process, and the mechanism and quality of referrals between the health center (Jimma Health Center-case, Ethiopia) and the Hospital. A sample of 459 paper-based records from the referral registration logbook were digitized as part of a retrospective observational study. For data preprocessing, visualization, and analysis, we developed a python-based interactive referral clinical pathway tool. The data collection was conducted from August to October 2019. Jimma Health Center’s RRL was used to examine how the referral decision was made and what cases were referred to the next level of care. However, the RRL was incomplete and did not contain the expected referral feedback from the hospital. Hence, we defined a new protocol to investigate the quality of referral. We compared the information in the health center’s RRL with the medical records in the hospital to which the patients were referred. A total of 201 medical records of referred patients were examined. Results A total of 459 and 201 RRL records from the health center and the referred hospital, respectively, were analyzed in the study. Out of 459, 86.5% referred cases were between the age of 20 to 30 years. We found that “better patient management”, “further patient management”, and “further investigation” were the main health-center referral reasons and decisions. It accounted for 40.08%, 39.22%, and 16.34% of all 459 referrals, respectively. The leading and most common referral cases in the health center were long labor, prolonged first and second stage labor, labor or delivery complicated by fetal heart rate anomaly, preterm newborn, maternal care with breech presentation, premature rupture of membranes, malposition of the uterus, and antepartum hemorrhage. In the hospital RRL and card-sheet, the main referral-in reasons were technical examination, expert advice, further management, and evaluation. We found it overall impossible to match records from the referral logbook in the health center with the patient files in the hospital. Out of 201, only 13.9% of records were perfect matching entries between health center and referred hospital RRL. We found 84%, 14.4%, and 1.6% were appropriate, unnecessary and unknown referrals respectively. Conclusion The paper illustrates the bottlenecks encountered in the quality assessment of the referrals. We analyzed the current status of the referral pathway, existing communications, guidelines and data quality, as a first step towards an end-to-end effective referral coordination and evidence-based referral service. Accessing, monitoring, and tracking the history of referred patients and referral feedback is challenging with the present paper-based referral coordination and communication system. Overall, the referral services were inadequate, and referral feedback was not automatically delivered, causing unnecessary delays.

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Section: Discussionmentioning

confidence: 99%

“…Literature evidence suggests that assisting the referral decision process through decision support systems enables to: (I). aid the process of filling out a referral template [ 11 ], (II). provide an alternative recommendation using historical records [ 12 ], and (III).…”

Section: Introductionmentioning

confidence: 99%

Analysis of low resource setting referral pathways to improve coordination and evidence-based services for maternal and child health in Ethiopia

et al. 2022

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“…Long waiting times for surgeries are also associated with higher risks of serious complications and death, especially among adults [ 16 , 17 ]. Amongst the research that has been done to improve referrals, positive decision support systems incorporating clinical guidelines and the collaboration of specialists have been found to be effective for general practice [ 18 ]. The reassurance of the necessity of the referral to the patient is also important because the non-attendance of some patients at surgery appointments is a major factor in prolonging waiting times for them and for other patients [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

The effectiveness of different patient referral systems to shorten waiting times for elective surgeries: systematic review

Rathnayake

Clarke

2021

BMC Health Serv Res

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Background Long waiting times for elective surgery are common to many publicly funded health systems. Inefficiencies in referral systems in high-income countries are more pronounced than lower and middle-income countries. Primary care practitioners play a major role in determining which patients are referred to surgeon and might represent an opportunity to improve this situation. With conventional methods of referrals, surgery clinics are often overcrowded with non-surgical referrals and surgical patients experience longer waiting times as a consequence. Improving the quality of referral communications should lead to more timely access and better cost-effectiveness for elective surgical care. This review summarises the research evidence for effective interventions within the scope of primary-care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries. Methods We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases in December-2019 to January-2020, for articles published after 2013. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer related surgeries. Both randomised and non-randomised controlled studies were eligible. The quality of evidence was assessed using ROBINS-I, AMSTAR 2 and CASP, as appropriate to the study method used. The review presentation was limited to a narrative synthesis because of heterogeneity. The PROSPERO registration number is CRD42019158455. Results The electronic search yielded 7543 records. Finally, nine articles were considered as eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality, with one randomised trial, two quasi-experimental studies, two longitudinal follow up studies, three systematic reviews and one observational study. All the six original articles were based on referral methods in high-income countries. The included research showed that patient triage and prioritisation at the referral stage improved timely access and increased the number of consultations of surgical patients in clinics. Conclusions The available studies included a variety of interventions and were of medium to high quality researches. Managing patient referrals with proper triaging and prioritisation using structured referral formats is likely to be effective in health systems to shorten the waiting times for elective surgeries, specifically in high-income countries.

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“…Long waiting times for surgeries are also associated with higher risks of serious complications and death, especially among adults (12,13). Amongst the research that has been done to improve referrals, positive decision support systems incorporating clinical guidelines and the collaboration of specialists have been found to be effective for general practice (14). Reassurance of the necessity of the referral to the patient is also important, because the nonattendance of some patients at surgery appointments is a major factor in prolonging waiting times for them and for other patients (15).…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Different Patient Referral Methods on Waiting Times for Adults Needing Elective Surgery - Systematic Review

Rathnayake¹,

Clarke²

2020

Preprint

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Background: Long waiting times and lengthy queues for elective surgery are common to many publicly funded health systems. Primary care practitioners play a major role in determining which patients are referred to the consultant surgeon and might represent an opportunity to improve this situation. With conventional methods of referrals, surgery clinics are often overcrowded with non-surgical referrals and surgical patients experience longer waiting times as a consequence. Improving the quality of referral communications should lead to more timely access and better cost-effectiveness for elective surgical care. This review summarises the research evidence for interventions within the scope of primary care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries.Methods: We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases in December 2019 to January 2020, for articles published after 2013. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer and cancer related surgeries. Randomised trials and non-randomised controlled studies were eligible. The main outcome variable of interest was waiting time for the elective surgery. The quality of evidence was assessed using ROBINS-I, AMSTAR 2 and CASP, as appropriate to the study method used. The review presentation was limited to a narrative synthesis because of heterogeneity. The PROSPERO registration number is CRD42019158455.Results: The electronic search yielded 7543 records. Finally, nine articles were considered as eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality, with one randomised trial, two quasi-experimental studies, two longitudinal follow up studies, three systematic reviews and one observational study. The included research showed that patient triage and prioritisation at the referral stage improved timely access and increased the number of consultations of surgical patients in clinics.Conclusions: The available studies included a variety of interventions and were of medium to high quality, showing that methods to improve the management of primary care referrals of patients for elective surgery can reduce waiting times and shorten waiting lists for elective surgery for adults.

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Clinical guidelines as decision support for referrals from primary care

Cited by 6 publications

References 23 publications

Analysis of low resource setting referral pathways to improve coordination and evidence-based services for maternal and child health in Ethiopia

Analysis of low resource setting referral pathways to improve coordination and evidence-based services for maternal and child health in Ethiopia

The effectiveness of different patient referral systems to shorten waiting times for elective surgeries: systematic review

The Effectiveness of Different Patient Referral Methods on Waiting Times for Adults Needing Elective Surgery - Systematic Review

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