Reducing Inappropriate Surgical Referrals Through Patient Assessment Algorithm Utilising Early Imaging: A Closed-Loop...

Area of Science:

• Healthcare Management
• Surgical Referral Auditing
• Diagnostic Imaging Optimization

Background:

• Emergency department (ED) referrals to general surgery (GS) face challenges including lack of standardization, incomplete assessments, and time constraints, leading to inappropriate referrals.
• These issues compromise patient care and strain National Health Service (NHS) resources.

Purpose of the Study:

• To evaluate the appropriateness of ED to GS referrals.
• To assess the impact of implementing an acute abdominal pain pathway with early computed tomography (CT) imaging on referral quality.

Main Methods:

• A closed-loop audit of ED to GS referrals was conducted in two cycles (July 2020 and July 2024).
• Data collected included assessment completeness, investigations, preliminary treatment, and diagnostic alignment.
• An intervention involving an acute abdominal pain pathway with early CT use was implemented between cycles.

Main Results:

• In Cycle 1, 27.9% of ED-to-GS referrals were inappropriate, with significant deficiencies in investigations and preliminary treatment.
• Following the intervention, inappropriate referrals decreased to 9.7% in Cycle 2 (p=0.004).
• Improvements were noted in the completeness of blood investigations (39.6% to 20%) and preliminary treatment (21.9% to 4.2%).

Conclusions:

• Structured referral pathways and early CT imaging are critical for improving ED-to-GS referral quality.
• The implemented pathway optimized resource allocation, improved patient flow, and reduced unnecessary admissions.
• This scalable model enhances clinical efficiency and patient outcomes, supporting NHS objectives for safe, cost-effective care.