Improving Emergency Referrals in a Philippine Tertiary Hospital: A Quality Improvement Initiative

Introduction Emergency referrals from outpatient clinics to emergency departments (EDs) are critical in managing acute medical conditions. This quality improvement (QI) study at a tertiary public hospital in the Philippines addressed delays and documentation issues in the emergency referral process. This study aimed to improve referral turnaround time and compliance through a structured quality improvement initiative. Methods A retrospective before-and-after quality improvement study was conducted from March to June 2023. Twenty referrals before and 20 after interventions were audited. Interventions included protocol training, assignment of a triage resident, structured verbal endorsement, nursing coordination, and a standardized referral checklist. The outcomes measured were turnaround time and documentation compliance. Results The average referral time decreased from 43.05 minutes to 15.75 minutes post-intervention, a 63% improvement. Documentation compliance improved from 75.15% to 98%. All post-intervention cases had complete vital signs, medical history, physical examination notes, and formal endorsement. Staff reported greater awareness of emergency indicators, and the changes were sustained without additional resources. Discussion The quality improvement initiative demonstrated that simple workflow redesigns, staff engagement, and role clarity significantly improved referral efficiency and documentation. The intervention aligned with Universal Health Care priorities and national mandates for continuous quality improvement. Its success highlights the value of resident-led coordination and checklists in public hospital settings. Conclusion Structured, low-cost interventions markedly improved emergency referrals from an outpatient department. The approach may be replicated in other public hospitals and adapted to different intrahospital transfers. Sustained improvements require integration into routine clinic operations and continued monitoring.