An electronic referral system supporting integrated hospital discharge

Abstract

Purpose The purpose of this paper is to evaluate the implementation and potential value of an electronic referral system to improve integrated discharge planning for hospitalised older adults with complex care needs. This new technology formed part of the “Common Assessment Framework for Adults” policy in England. Design/methodology/approach Mixed methods were undertaken as part of a case study approach within an acute hospital in the North West of England. First, qualitative interviews were undertaken with practitioners to explore early experiences using the new technology. Second, routinely collected administrative data were analysed, comparing referrals made using the new technology and those made through the usual paper-based process. Findings Qualitative interviews found that an electronic discharge system has, in principle, the potential to improve the efficiency and suitability of integrated care planning. However, the implementation proved fragile to decisions taken elsewhere in the local care system, meaning its scope was severely curtailed in practice. Several “socio-technical” issues were identified, including the loss of valuable face-to-face communication by replacing manual with electronic referrals. Research limitations/implications The small number of patients referred during the implementation phase meant that patient outcomes could not be definitively judged. Research into the longer-term implications and value of electronic referral systems is needed. Originality/value There is concern that attempts to integrate health and social care are stymied by incompatible systems for recording service user information. This research explores a novel attempt to share assessment information and improve support planning across health and social care boundaries.

What is the effect of electronic clinical handovers on patient outcomes? A systematic review

“…Contrastingly, Wilberforce et al 23 reported that 21 per cent of e-handover documents contained incomplete fields versus 13 per cent of paper documents ( p = 0.039). 23…”

“…Wilberforce et al, 23 the only study to demonstrate a reduction in handover completeness post-implementation failed to describe if their e-handover platform had the same number of fields as the paper documentation or how they selected handovers to audit. It is therefore unclear if their findings are a result of selection bias or a genuine reduction in completed handovers.…”

“…26,27 A variety of outcome measures were reported, which will be compared under the following subheadings: length of stay, adverse events, time to procedure and handover completeness (see Table 3). 16 Chen et al 17 Clarke et al 18 Nazar et al 19 Patel et al 20 Raptis et al 21 Ryan et al 22 Singleton et al 24 Wilberforce et al 23 Length of stay. Length of stay was reported in three studies, with conflicting results.…”

“…A treatment plan was included only in 52.3 per cent of paper handovers compared to 94.7 per cent (p < 0.0001) of e-handovers. Contrastingly, Wilberforce et al23 reported that 21 per cent of e-handover documents contained incomplete fields versus 13 per cent of paper documents (p = 0.039) 23.…”

Electronic Information Sharing Between Nursing and Adult Social Care Practitioners in Separate Locations: A Mixed-Methods Case Study

“…This is perhaps a consequence of health and social care practitioners being in separate locations and lacking the opportunity for and benefits of informal corridor conversations (González-Martínez et al, 2015). Other research conducted in a district general hospital within the same demonstration programme demonstrated that face-to-face transfer of information was preferable to electronic transfer between ward staff and discharge coordinators (Wilberforce et al, 2017). Van der Meiden and colleagues (2003) suggested that the successful implementation of a computer-based information system was a relative concept, perceptions of which may change over time.…”