An Effective Electronic Surgical Referral System

Abstract

INTRODUCTION Electronic booking of out-patient appointments is being rolled out in England under the 'Choose and Book' programme. We set up and ran a local electronic surgical referral service before this. This paper assesses the effect of the electronic surgical referral service on patient waiting times and attendance rates.PATIENTS AND METHODS The study included 54 patients referred electronically and 189 referred on paper to a single colorectal surgical service over the same period. RESULTS The appointment booking was achieved on the same day as the referral was made for the majority of electronic referrals whereas it took an average of 7 days for paper referrals. There was no significant difference in the time from referral to being seen in clinic between the two groups. Patients referred electronically were much more likely to attend for their appointment. CONCLUSIONS This study shows that an electronic surgical referral system can improve efficiency. This may be because this system allows enhanced patient choice of appointment date and time.

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

“…18,19,21,22,25,27,40,41,44,61,75,78,80,83,84,88,91,[97][98][99]106,113,118,121,123,124,132,135,138,[140][141][142]147,148,152,153,155,158 Of the non-intervention views and predictors studies, the 33 qualitative studies consisted of qualitative interview studies (n = 25 20,163-165,171,177,178,180,183,192,194,196,201,204,207,210,212,213,237,239,245,249,253,258,260 ), focus group studies (n = 5 217,230,232,252,257 ), studies using both interviews and focus groups (n = 2 196,239 ) and one study which used transcriptions of video tapes. 182 The non-intervention quantitative studies (n = 117) were mostly cross-sectional surveys (n = 82 29,108,161,[168][169][170][171][172]…”

“…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.…”

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.…”

A Patient-based Hospital Referral Decision Support System

“…Several promising ER systems have been developed for variety of health services [10,11,12,13]. ER process is a complex and critical activity which involves referral decisions and referral communications [14,15,16,17].…”