Email triage of new neurological outpatient referrals from general practice

Abstract

Objectives: To determine whether an email triage system between general practitioners and a neurologist for new outpatient referrals is feasible, acceptable, efficient, safe, and effective. Methods: This was a prospective single cohort study on the interface between primary care practitioners and the neurology clinic of a district general hospital. Seventy six consecutive patients with neurological symptoms from nine GPs, for whom a specialist opinion was deemed necessary, were entered in the study. The number of participants managed without clinic attendance and the reduction in neurologist's time compared with conventional consultation was measured, as was death, other specialist referral, and change in diagnosis in the 6 months after episode completion. The acceptability for GPs was ascertained by questionnaire. Results: Forty three per cent of participants required a clinic appointment, 45% were managed by email advice alone, and 12% by email plus investigations. GP satisfaction was high. Forty four per cent of the neurologist's time was saved compared with conventional consultation. No deaths or significant changes in diagnosis were recorded during the 6 month follow up period. Conclusions: Email triage is feasible, acceptable to GPs, and safe. It has the potential for making the practice of neurologists more efficient, and this needs to be tested in a larger randomised study.

What is the evidence on interventions to manage referral from primary to specialist non-emergency care? A systematic review and logic model synthesis

“…Of the 140 interventions, the majority were conducted in the UK (n = 82 18,19,[21][22][23]26,28,[30][31][32]34,37,38,64,65,68,70,71,73,74,[76][77][78][79][80][82][83][84][85]94,96,99,103,104,106,109,114,116,117,119,122,[124][125][126]128,129,131,133,139,140,142,143,[152][153][154][155][156][157]159,160 ) or the USA (n = 20 …”

“…[97][98][99][100][101][102][103][104][105][106] Although each system differed, and included referral to different specialties, they all consisted of referral via an online system as opposed to via letter or e-mail. In one case a clinical reviewer assessed the referral for appropriateness, 100 and in a second study a referral pro forma was included to try to guide appropriate referral, but in all other studies all referrals were accepted.…”

“…In one case a clinical reviewer assessed the referral for appropriateness, 100 and in a second study a referral pro forma was included to try to guide appropriate referral, but in all other studies all referrals were accepted. Two studies 103,104 also included aspects of specialist consultation but this was not the main focus of the intervention. Nine of the interventions reported a positive effect [97][98][99][100][101][102][103][104][105] and all studies were considered to be at lower risk of bias.…”

Referral interventions from primary to specialist care: a systematic review of international evidence

“…Process changes were defined as smallscale changes to some aspect of the individual referral process that did not involve the movement of staff or relocation of clinics, the methods in which referrals were triaged at hospital, or financial arrangements for referral. Process change interventions included: designated appointment slots and fast-track clinics for primary care referrals (n = 6), [60][61][62][63][64][65] direct access to screening (n = 9), 66 to referral (individual contact between a specialist and GP) (n = 11), [75][76][77][78][79][80][81][82][83][84][85] electronic referral systems (n = 10), [86][87][88][89][90][91][92][93][94][95] decision support tools (n = 10), [96][97][98][99][100][101][102][103][104][105] and waiting list review or watchful waiting (n = 3). [106][107][108] The overall picture for interventions that aim to moderate referral outcomes by changing an element of the referral process is mixed.…”

Investigando enfermedades raras del adulto en atención primaria: una hipótesis clasificatoria

“…La forma de intercambiar la información con los especialistas hospitalarios y con los expertos ha sido mediante el contacto directo, con desplazamientos al centro hospitalario o al laboratorio de referencia. También por medio del teléfo-no, del servicio nacional de correos y finalmente por medio del correo electrónico que es un instrumento de especial utilidad para la investigación y el manejo de las ER en atención primaria (2)(3)(4)(5). La sospecha de los casos de RAMR fue iniciada mediante la comunicación de la tarjeta amarilla a la Unidad de Farmacovigilancia Regional.…”