E-referrals: improving the routine interspecialty inpatient referral system

Area of Science:

• Healthcare Management
• Clinical Informatics
• Patient Safety

Background:

• Interspecialty referrals are critical in inpatient care, with high weekly volumes necessitating efficient and safe processes.
• The existing paper-based system faced challenges including inefficiency, lack of traceability, and delays, impacting patient safety and junior doctor workload.
• A Trust incident underscored the critical need for improvements in the inpatient referral pathway.

Purpose of the Study:

• To enhance patient safety within the inpatient referral process.
• To improve the efficiency of junior doctors managing interspecialty referrals.
• To develop and implement a robust electronic referral system.

Main Methods:

• Utilized appreciative inquiry and the Plan-Do-Study-Act (PDSA) model for system development and iterative improvement.
• Piloted an electronic referral system within two specialties, incorporating user feedback for refinement.
• Expanded the electronic system across multiple specialties, adding features like referral acknowledgment for tracking.

Main Results:

• Qualitative data from 31 users indicated improvements in patient safety and user experience.
• Referral submission times decreased from an average of 2.1 hours to 1.9 hours post-implementation.
• A statistically significant improvement in referral timings was observed on a statistical process control chart, with faster patient reviews as an unexpected benefit.

Conclusions:

• The electronic referral system proved more efficient and safer than the previous paper-based method.
• The new system provides a fully auditable inpatient referral pathway with enhanced traceability.
• The successful, sustainable change is being rolled out Trust-wide, offering a model for other institutions reviewing referral pathways.