E-referrals: improving the routine interspecialty inpatient referral system.

2.50
Hdl Handle:
http://hdl.handle.net/11287/620891
Title:
E-referrals: improving the routine interspecialty inpatient referral system.
Authors:
Shephard, Emma; Stockdale, Claire; May, Felix; Brown, Alistair; Lewis, Hannah; Jabri, Sara; Robertson, Daniel; Moss, Victoria; Bethune, Rob
Abstract:
Interspecialty referrals are an essential part of most inpatient stays. With over 130 referrals occurring per week at the Royal Devon and Exeter Hospital, the process must be efficient and safe. The current paper-based 'white card' system was felt to be inefficient, and a Trust incident highlighted patient safety concerns. Questionnaires reinforced the need for improvement, with concerns such as a lack of referral traceability and delays in the referral delivery due to workload. The aims of the project were to improve patient safety and junior doctor efficiency in the referral process. Through appreciative enquiry and the PDSA (Plan-Do-Study-Act) model, an electronic referral system was developed, piloted within two specialties and later expanded to others with improvements made along the way based on user feedback. The system includes novel features including specialties 'acknowledging' a referral to allow referral progress to be tracked. The system stores all referrals, creating a fully auditable inpatient referral pathway. Qualitative data indicated improvement to patient safety and user experience (n=31). Timings for referrals were measured over a 6-month period; referrals became faster with the electronic system, with average time from decision to refer to referral submission improving from 2.1 hours to 1.9 hours, with a noted statistically significant improvement in timings on a statistical process control chart. An unexpected benefit was that patients were also reviewed faster by specialties. Measuring these changes presented a significant challenge due to the complexity of the referral process, and this was a big limitation. Overall, the re-design of a paper-based referral system into an electronic system has been proven to be more efficient and felt to be safer for patients. This is a sustainable change which is being rolled out Trust-wide. We hope that the reporting of this project will help others considering reviewing their inpatient referral pathways.
Citation:
E-referrals: improving the routine interspecialty inpatient referral system. 2018, 7 (3):e000249 BMJ Open Qual
Publisher:
BMJ
Journal:
BMJ Open Quality
Issue Date:
Sep-2018
URI:
http://hdl.handle.net/11287/620891
DOI:
10.1136/bmjoq-2017-000249
PubMed ID:
30306139
Additional Links:
https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/30306139/
Note:
This article is freely available via Open Access. Click on the Additional Link above to access the full-text via the publisher's site.
Type:
Journal Article
Language:
en
ISSN:
2399-6641
Appears in Collections:
Colorectal Surgery; 2018 RD&E publications; Quality Improvement

Full metadata record

DC FieldValue Language
dc.contributor.authorShephard, Emmaen
dc.contributor.authorStockdale, Claireen
dc.contributor.authorMay, Felixen
dc.contributor.authorBrown, Alistairen
dc.contributor.authorLewis, Hannahen
dc.contributor.authorJabri, Saraen
dc.contributor.authorRobertson, Danielen
dc.contributor.authorMoss, Victoriaen
dc.contributor.authorBethune, Roben
dc.date.accessioned2018-11-08T10:47:48Z-
dc.date.available2018-11-08T10:47:48Z-
dc.date.issued2018-09-
dc.identifier.citationE-referrals: improving the routine interspecialty inpatient referral system. 2018, 7 (3):e000249 BMJ Open Qualen
dc.identifier.issn2399-6641-
dc.identifier.pmid30306139-
dc.identifier.doi10.1136/bmjoq-2017-000249-
dc.identifier.urihttp://hdl.handle.net/11287/620891-
dc.description.abstractInterspecialty referrals are an essential part of most inpatient stays. With over 130 referrals occurring per week at the Royal Devon and Exeter Hospital, the process must be efficient and safe. The current paper-based 'white card' system was felt to be inefficient, and a Trust incident highlighted patient safety concerns. Questionnaires reinforced the need for improvement, with concerns such as a lack of referral traceability and delays in the referral delivery due to workload. The aims of the project were to improve patient safety and junior doctor efficiency in the referral process. Through appreciative enquiry and the PDSA (Plan-Do-Study-Act) model, an electronic referral system was developed, piloted within two specialties and later expanded to others with improvements made along the way based on user feedback. The system includes novel features including specialties 'acknowledging' a referral to allow referral progress to be tracked. The system stores all referrals, creating a fully auditable inpatient referral pathway. Qualitative data indicated improvement to patient safety and user experience (n=31). Timings for referrals were measured over a 6-month period; referrals became faster with the electronic system, with average time from decision to refer to referral submission improving from 2.1 hours to 1.9 hours, with a noted statistically significant improvement in timings on a statistical process control chart. An unexpected benefit was that patients were also reviewed faster by specialties. Measuring these changes presented a significant challenge due to the complexity of the referral process, and this was a big limitation. Overall, the re-design of a paper-based referral system into an electronic system has been proven to be more efficient and felt to be safer for patients. This is a sustainable change which is being rolled out Trust-wide. We hope that the reporting of this project will help others considering reviewing their inpatient referral pathways.en
dc.language.isoenen
dc.publisherBMJen
dc.relation.urlhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/30306139/en
dc.rightsArchived with thanks to BMJ Open Quality. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.en
dc.subjectWessex Classification Subject Headings::Patients. Primary care. Medical profession. Forensic medicineen
dc.titleE-referrals: improving the routine interspecialty inpatient referral system.en
dc.typeJournal Articleen
dc.identifier.journalBMJ Open Qualityen
dc.description.noteThis article is freely available via Open Access. Click on the Additional Link above to access the full-text via the publisher's site.en
dc.type.versionPublisheden

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