Neurosurgery-Led Digital Emergency Referral System in Khyber Pakhtunkhwa, Pakistan: Protocol for a Mixed Methods...

Area of Science:

• Health Informatics
• Emergency Medicine
• Health Systems Strengthening

Background:

• Low- and middle-income countries (LMICs) face significant challenges in emergency referral systems, marked by delays and miscommunication.
• Khyber Pakhtunkhwa (KP), Pakistan, has a fragmented, paper-based referral system overwhelming tertiary hospitals with unnecessary cases.
• This leads to overcrowding, resource depletion, and compromised specialist care delivery.

Purpose of the Study:

• To design, implement, and evaluate a digital emergency referral platform for neurosurgery in KP.
• The KP Medical Teaching Institution (MTI) Referral Application aims to decrease unnecessary referrals and response times.
• Key goals include optimizing bed use and improving inter-facility communication.

Main Methods:

• A convergent mixed methods design combining a quantitative prospective cohort study and qualitative exploration.
• Quantitative arm: Census of referrals via the digital platform over a 6-month pilot (June-Nov 2026).
• Qualitative arm: Surveys, interviews, and focus groups with healthcare professionals and patients.

Main Results:

• System development, stakeholder engagement, and platform validation are complete.
• Participant recruitment and pilot deployment are scheduled for June 2026.
• Data analysis is planned from Dec 2026-Feb 2027, with dissemination in Spring 2027.

Conclusions:

• This protocol details a multimodal assessment of a digital referral system in a resource-constrained LMIC.
• Successful implementation could provide evidence for wider adoption of digital referral platforms in KP and similar regions.
• The study anticipates improved referral efficiency and communication, enhancing emergency care delivery.