Referral Finder: Saving Time and Improving The Quality of In-hospital Referrals

Abstract

Making referrals to other hospital specialties is one of the key duties of the foundation doctor, which can be difficult and time consuming. In Ninewells hospital, Scotland, in our experience the effectiveness of referrals is limited by contact details not being readily accessible and foundation doctors not knowing what information is relevant to each specialty.We surveyed foundation doctors on their experience of the existing referral process to identify where we needed to focus to improve the process. The doctors reported significant delays in obtaining contact details from the operator, and found they did not know the specific information needed in each referral.To increase the information available to foundation doctors, we set up a page on the staff intranet called 'Referral Finder'. This page includes contact details, guidelines for referral, and links to relevant protocols for each specialty. By making this information readily accessible our objective was to increase the speed and quality of referrals.When surveyed two months after the web page was established, foundation doctors reported a reduction in calls to operator from baseline and reported achieving more effective referrals. When asked to comment, many doctors asked if the page could include details for other hospitals in our health board and provide more specialty specific information.This feedback prompted us to extend the scope of the page to include the district general hospital in our region, and update many of the existing details. Doctors were then surveyed after the updates, 100% agreed that the website saved time and there was a 49.3% reduction in doctors who reported not knowing the specific information needed for a referral.Having adequate information improved referrals and resulted in time saved. This would allow more time for patient care. The quality improvement project was praised among doctors as a useful, innovative and replicable project. ProblemIn Ninewells hospital, Dundee, Scotland, foundation doctors spent considerable time accessing referral contact details via the operator. This resulted in significant delays which impacted on other ward jobs and patient care. After obtaining the contact details from the operator, more time was spent accumulating patient information by the doctor to make the referral. Despite this, referrals were often lacking specific information resulting in inadequate referrals.Ninewells is a large teaching hospital with 26 specialties where the referral process, and the specific information required for referral, varies between each specialty. Existing paper records of referral contact details in the wards were incomplete and were not kept updated. In addition, there was no guidance on what to include in the referral for any specialty. As two foundation doctors, we had encountered frustration at wasted time, incomplete referrals, and patient safety issues caused by the lack of available referral information. We felt a simple online page where referral information was kept would mean the informat...

E-referrals: improving the routine interspecialty inpatient referral system

“…A literature search revealed a project aiming to tackle this issue in another Trust, where a ‘Referral Finder’ page was introduced on the Trust intranet which explained how to make referrals to different specialties. 4 However, this does not streamline the process and could therefore still lead to errors as each specialty may have a different referral method. Our project does not necessarily completely fill the knowledge gap in this area, especially because we used a computer system that is unique to our Trust, however it does illustrate an original referral system developed within a Trust and raises further questions regarding patient safety and routine referrals.…”

Audit of medication allergy referrals to an allergy outpatient service at a tertiary hospital

“…The use of letter templates helps improve the quality of referrals and saves time. 8,11 Since electronic referrals facilitate effective and complete referrals, a potential barrier to effective referrals includes not having the technological infrastructure to support electronic referrals. 12 It is interesting to note that areas that generally showed the highest compliance rates are those considered the essential parameters of the medication allergy referralthese include the name of the index medication, and a description of the reaction ( Table 1).…”

“…Consistent with this, fields that can be automatically populated in the letters (such as past medical history) were more complete in GP referrals than in internal hospital referrals (Table 1). The use of letter templates helps improve the quality of referrals and saves time 8,11 . Since electronic referrals facilitate effective and complete referrals, a potential barrier to effective referrals includes not having the technological infrastructure to support electronic referrals 12 …”

Junior doctor-led quality improvement project to improve safety and visibility of an interspecialty referral system

“…7 8 Others have looked at systems to reduce frustration from time to complete referrals and patient safety issues caused by poor interspecialty referrals. 9 Many hospitals still rely heavily on paging devices (bleeps) for urgent front-of-house referrals. However, there is increasing adoption of innovative online referral systems with demonstrated benefit.…”