Improving resident doctor referrals to specialties: a 5-year evaluation of a centralised referrals sheet

Referrals are a fundamental part of working life for a resident doctor, where an efficient system is needed when liaising with different specialties. Within a secondary care district general hospital, a lack of standardised protocols was recognised, which can lead to delays in patient care. The aim of this project was to improve knowledge and confidence among resident doctors when referring to specialties. A baseline study highlighted a lack of confidence among resident doctors, often relying on other colleagues when referring to each specialty. Our team created a comprehensive referrals sheet, through a series of plan-do-study-act (PDSA) cycles across a 5-year period, from 2019 to 2024. This referrals sheet described routine, urgent and out-of-hours referrals pathways for each specialty and was uploaded to the hospital's intranet for centralised access. This was then re-evaluated to assess the short-term and long-term impact of this intervention. This project resulted in a widespread improvement of doctors' knowledge of referrals within the hospital, with an average confidence of inpatient referral from 49.0% to 74.4%, and outpatient referral from 28.0% to 57.0%. This study not only solidifies the referrals sheet as a useful and sustainable resource, but highlights the importance of PDSA cycles and direct improvements in clinical workflow. Future directions could aim at referrals being integrated with hospital software, as some specialties have begun to do.