Designing and describing an electronic referral system to facilitate direct hospital admissions

Abstract

Background In France, the progressive use of emergency departments (EDs) by primary care providers (PCPs) as a point of access to hospitalization for nonurgent patients is one of the many causes of their overcrowding. To increase the proportion of direct hospital admissions, it is necessary to improve coordination between PCPs and hospital specialists. The objective of our work was to describe the design and implementation of an electronic referral system aimed at facilitating direct hospital admissions. Methods This initiative was conducted in a French area (Hauts-de-Seine Sud) through a partnership between the Antoine-Béclère University Hospital, the Paris-Saclay University Department of General Medicine and the local health care network. The implementation was carried out in 3 stages, namely, conducting a survey of PCPs in the territory about their communication methods with the hospital, designing and implementing a web-based application called “SIPILINK” (Système d'Information de la Plateforme d’Intermédiation Link) and an innovative organization for hospital management of the requests, and analysing through descriptive statistics the platform use 9 months after launch. Results The e-referral platform was launched in November 2019. First, a PCP filled out an electronic form describing the reason for his or her request. Then, a hospital specialist worked to respond within 72 h. Nine months after the launch, 132 PCPs had registered for the SIPILINK platform, which represented 36.6% of PCPs in this area. Of the 124 requests made, 46.8% corresponded to a hospitalization request (conventional or day hospitalization). The most requested specialty was internal medicine (48.4% of requests). The median time to first response was 43 min, and 43.5% of these requests resulted in direct admission (conventional or day hospitalization). Conclusions This type of system responds to a need for coordination in the primary-secondary care direction, which is less often addressed than in the secondary-primary care direction. The first results show the potential of the system to facilitate direct admissions within a short time frame. To make the system sustainable, the next step is to extend its use to other hospitals in the territory.

Improving Direct Admissions to Internal Medicine Services

“…Two prior studies in similar settings, one implementing a protocolized step-by-step flow diagram 9 and the other utilizing the transfer center for DA intakes, 10 were limited to smaller volumes of DAs. In addition, our intervention took a practical approach, utilizing low-cost and generalizable EMR tools that may be more easily implemented than previous studies staffing a telephone hotline 8 or setting up a referral and care coordination system 11 . Our study also detailed a guide for DA process improvement including considerations when developing a team, making a preintervention assessment survey, creating a process map, designing a low-cost and generalizable intervention, and performing an outreach campaign.…”

Emergency department overcrowding: causes and solutions

“…[2–4] However, patients presenting with nonurgent conditions to the ED causes overcrowding. [2,5,6] Emergency department overcrowding is among the biggest and most important problems ED staff experience. [3] The number of ED visits is on the increase and remains an unresolved problem.…”