Electronic optional guidelines as a tool to improve the process of referring patients to specialized care: An intervention study

Abstract

ObjectiveThe main objective of this paper is to investigate whether incorporating an electronic optional guideline tool (EOGT) in the standardized referral template used by general practitioners (GPs) when referring patients to specialized care can improve outpatient referral appropriateness.DesignIntervention study with an intervention and a control group.Setting210 GPs in the municipality of Bergen and the Department of Thoracic Medicine at Haukeland University Hospital.Subjects2400 patients referred to the Department of Thoracic Medicine at Haukeland University Hospital.ResultsAn electronic optional guideline tool (EOGT) was implemented on 93 of 210 GPs’ computer systems. The referral quality and the time spent reviewing each referral were evaluated by the hospital specialists. The GPs did not know that their referrals were being evaluated. The specialists were blinded with regard to information concerning the intervention and the control group. The specialists reported significantly higher referral quality and considerably less time spent on evaluating referrals when using the EOGT, with an overall time reduction of 34%. Likewise, GPs also reported that the EOGT was easy to use, time-saving and led to an improved quality of their referrals.ConclusionThis study documents an improvement in the quality of the referrals. Since the GPs save time by using the EOGT, there is no reason to believe that they will discontinue using it. In fact, the tool may be even more beneficial for the GP. The authors believe that it is possible to implement the EOGT as a standard referral tool within various fields of medicine and are currently in the process of developing these tools.

Improving quality of referral letters from primary to secondary care: a literature review and discussion paper

“…Evans (2009) 4 Improvement in referral quality and reducing inappropriate demand Xiang et al (2013) 3 Improvement in referral quality and decisions made will be more accurate Elwyn et al (2007) 3 Improving the quality of referrals and reducing demand Templates Haley et al (2015) 3 Improvement in documentation Rokstad et al (2013) 4 Improvement in referral quality and in time efficiency by the specialist reviewing the letters Wahlberg et al (2015) 3 Improvement in documentation Wahlberg et al (2016) 3 Sought to prove association with patient experience compared with control but none seen Wahlberg et al (2017) 3 Sought to prove association with improved quality of care through quality indicators but none seen Eskeland et al (2017) 3 Improvement in referral quality Jiwa et al (2014) 3 Improvement in documentation of clinically relevant data. Referral times unchanged.…”

Rettighetsvurdering og kvalitet på henvisninger – grad av samsvar mellom fire smertesentre

“…Systemet ble benyttet av 93 (intervensjonsgruppen) av i alt 210 fastleger. Kvaliteten på henvisningene ble signifikant bedre, og tidsbruken gikk ned (25). Våre funn understreker behovet for en fastere struktur som kan veilede henviser i hvilken informasjon som er nødvendig.…”

Kunsten å henvise

“…Imidlertid har vi gjennom de siste 15 år sett at en mal alene ikke hjelper stort for å bedre kommunikasjonen (9). Mulighet for bruk av algoritmebaserte løsninger med elektronisk beslutningsstøtte har vaert et ønske fra allmennlegenes side (10). Digital dialog mellom fastleger og sykehus er innført flere steder i landet.…”