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Dennison, Jessica, Sarah Eisen, Matthew Towers, and Celia Ingham Clark. "An Effective Electronic Surgical Referral System." Annals of The Royal College of Surgeons of England 88, no. 6 (October 2006): 554–56. http://dx.doi.org/10.1308/003588406x130642.
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INTRODUCTION Electronic booking of out-patient appointments is being rolled out in England under the ‘Choose and Book’ programme. We set up and ran a local electronic surgical referral service before this. This paper assesses the effect of the electronic surgical referral service on patient waiting times and attendance rates. PATIENTS AND METHODS The study included 54 patients referred electronically and 189 referred on paper to a single colorectal surgical service over the same period. RESULTS The appointment booking was achieved on the same day as the referral was made for the majority of electronic referrals whereas it took an average of 7 days for paper referrals. There was no significant difference in the time from referral to being seen in clinic between the two groups. Patients referred electronically were much more likely to attend for their appointment. CONCLUSIONS This study shows that an electronic surgical referral system can improve efficiency. This may be because this system allows enhanced patient choice of appointment date and time.
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Shephard, Emma, Claire Stockdale, Felix May, Alistair Brown, Hannah Lewis, Sara Jabri, Daniel Robertson, Victoria Moss, and Rob Bethune. "E-referrals: improving the routine interspecialty inpatient referral system." BMJ Open Quality 7, no. 3 (September 28, 2018): e000249. http://dx.doi.org/10.1136/bmjoq-2017-000249.
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Interspecialty referrals are an essential part of most inpatient stays. With over 130 referrals occurring per week at the Royal Devon and Exeter Hospital, the process must be efficient and safe. The current paper-based ’white card' system was felt to be inefficient, and a Trust incident highlighted patient safety concerns. Questionnaires reinforced the need for improvement, with concerns such as a lack of referral traceability and delays in the referral delivery due to workload. The aims of the project were to improve patient safety and junior doctor efficiency in the referral process. Through appreciative enquiry and the PDSA (Plan-Do-Study-Act) model, an electronic referral system was developed, piloted within two specialties and later expanded to others with improvements made along the way based on user feedback. The system includes novel features including specialties ’acknowledging' a referral to allow referral progress to be tracked. The system stores all referrals, creating a fully auditable inpatient referral pathway. Qualitative data indicated improvement to patient safety and user experience (n=31). Timings for referrals were measured over a 6-month period; referrals became faster with the electronic system, with average time from decision to refer to referral submission improving from 2.1 hours to 1.9 hours, with a noted statistically significant improvement in timings on a statistical process control chart. An unexpected benefit was that patients were also reviewed faster by specialties. Measuring these changes presented a significant challenge due to the complexity of the referral process, and this was a big limitation. Overall, the re-design of a paper-based referral system into an electronic system has been proven to be more efficient and felt to be safer for patients. This is a sustainable change which is being rolled out Trust-wide. We hope that the reporting of this project will help others considering reviewing their inpatient referral pathways.
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Al Shamsi, Hilal Salim, Abdullah Ghthaith Almutairi, and Sulaiman Salim Al Mashrafi. "Assessing the Quality of the Saudi Healthcare Referral System: Potential Improvements Implemented by Other Systems." Global Journal of Health Science 10, no. 11 (October 13, 2018): 113. http://dx.doi.org/10.5539/gjhs.v10n11p113.
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INTRODUCTION: The referral system authorizes and transfers the responsibility for healthcare services from one provider to another. A key component of the system is the communication between primary-care and specialist providers. Poor communication between them is detrimental to and can cause significant issues with coordination of effective care.
OBJECTIVE: The purpose of this review was to evaluate current healthcare referral systems, focusing on the communication among providers, and to suggest practices that could make the Saudi healthcare referral system more effective.
DESIGN: This systematic review identified published studies of the quality of the healthcare referral system in Saudi Arabia and other countries using two databases, Medline and PubMed. Data were summarized and extracted into two tables.
RESULTS: The review included 12 studies that met its selection criteria. These studies were conducted in various regions of Saudi Arabia, but mostly the west and north. The 12 studies included 181,192 participants, with numbers of participants ranging from 21 to 138,484. The present review found that more than 50% of the referral documents and feedback reports in these studies had incomplete patient information. Implementation of electronic referrals (e-referrals) in several countries, including Australia, New Zealand and the United States, improved their referral systems, particularly by solving the problem of incomplete referral documents. In addition, the present review found that in some specialist clinics, referral cases contributed to increased workloads. One study reported on implementation of Lean Six Sigma principles in a military hospital in western Saudi Arabia, which reduced the number of referrals delayed, inappropriate referrals and the response time to referrals (7%). E-referrals and Lean Six Sigma principles may be applicable in Saudi Arabia as solutions to referral and response-time problems.
CONCLUSIONS: An increase in healthcare referrals in Saudi Arabia has caused an increase in missing essential information in referral letters and feedback reports as well as overcrowding in specialist clinics. The results of the present review suggested that implementing e-referral and Lean Six Sigma principles may improve the quality of Saudi Arabia’s healthcare referral system.
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Kline, Teri A., and Donald R. Self. "The Referral System." Health Marketing Quarterly 6, no. 1-3 (May 16, 1989): 117–24. http://dx.doi.org/10.1300/j026v06n01_06.
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Sweeney, B. "The referral system." BMJ 309, no. 6963 (November 5, 1994): 1180–81. http://dx.doi.org/10.1136/bmj.309.6963.1180.
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Griffiths, C. H. "Draconian referral system." British Dental Journal 213, no. 1 (July 2012): 4–5. http://dx.doi.org/10.1038/sj.bdj.2012.566.
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Hendijani, Rosa, and Diane P. Bischak. "The effect of social relationships on the rates of referral to specialists." International Journal of Operations & Production Management 36, no. 4 (April 4, 2016): 384–407. http://dx.doi.org/10.1108/ijopm-02-2015-0086.
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Purpose – In order to decrease patient waiting time and improve efficiency, healthcare systems in some countries have recently begun to shift away from decentralized systems of patient referral from general practitioners (GPs) to specialists toward centralized ones. From a queueing theory perspective, centralized referral systems can decrease waiting time by reducing the variation in the referral process. However, from a social psychological perspective, a close relationship between referring physician and specialist, which is characteristic of decentralized referral systems, may safeguard against high referral rates; since GPs refer patients directly to the specialists whom they know, they may be reluctant to damage that relationship with an inappropriate referral. The purpose of this paper is to examine the effect upon referral behavior of a relationship between physicians, as is found in a decentralized referral system, vs a centralized referral system, which is characterized by an anonymous GP-specialist relationship. In a controlled experiment where family practice residents made decisions concerning referral to specialists, physicians displaying high confidence referred significantly fewer patients in a close relationship condition than in a centralized referral system, suggesting that for some physicians, referral behavior can be affected by the design of the service system and will, in turn, affect system performance. Design/methodology/approach – The authors used a controlled experiment to test the research hypotheses. Findings – Physicians displaying high confidence referred significantly fewer patients in a close relationship condition than in a centralized referral system, suggesting that for some physicians, referral behavior can be affected by system attributes and will, in turn, affect system performance. Research limitations/implications – The current study has some limitations, however. First, the sample consisted only of family practice residents and did not have the knowledge and experience of GPs regarding the referral process. Second, the authors used hypothetical patient case descriptions instead of real-world patients. Repeating this experiment with primary care physicians in real setting would be beneficial. Practical implications – The study indicates that decentralized referral systems may act (rightly or wrongly) as a restraint on the rate of referrals to specialists. Thus, an implementation of a centralized referral system should be expected to produce an increase in referrals simply due to the change in the operational system setup. Even if centralized referral systems are more efficient and can facilitate the referral process by creating a central queue rather than multiple single queues for patients, the removal of social ties such as long-term social relationships that are developed between GPs and specialists in decentralized referral systems may act to counterbalance these theoretical gains. Social implications – This study provide support for the idea that non-clinical factors play an important role in referrals to specialists and hence in the quality of provided care, as was suggested by previous studies in this area (Hajjaj et al., 2010; Reid et al., 1999). The design of the service system may inadvertently influence some doctors to refer too many patients to specialists when there is no need for a specialist visit. In high-utilization health systems, this may cause some patients to be delayed (or even denied) in obtaining specialist access. Healthcare systems may be able to implement behavioral-based techniques in order to mitigate the negative consequences of a shift to centralized referral systems. One approach would be to try to create a feeling of close relationship among doctors in centralized referral systems. High communication and frequent interaction among GPs and specialists can boost the feelings of teamwork and personal efficacy through social comparison (Schunk, 1989, 1991) and vicarious learning (Zimmerman, 2000), which can in turn motivate GPs to take control of the patient care process when appropriate, instead of referring patients to specialists. Originality/value – The authors’ study is the first examining the effect of social relationships between GPs and specialists on the referral patterns. Considering the significant implications of referral decisions on patients, doctors, and the healthcare systems, the study can shed light into a better understanding of the social and behavioral aspects of the referral process.
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Pensuwan, Waraluk, Chukiat Viwatwongkasam, Pratana Satitvipawee, and Pichitpong Soontornpipit. "E-Referral System by Means of Decision Support System." Applied Mechanics and Materials 781 (August 2015): 587–90. http://dx.doi.org/10.4028/www.scientific.net/amm.781.587.
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This research aims to study, analyze, design and develop a web-based referral system for the recommendation of appropriate referred hospitals. Decision support system is applied to reduce time to find provider information that qualify with referral policy, medical specialists, bed, healthcare coverage, how emergency, distance and transportation time. This e-referral system scopes referral area from Siriraj hospital to other health care providers in Bangkok and metropolitan region (Nakhon Pathom, Nonthaburi, Pathum Thani, Samut Prakan and Samut Sakhon), with a total of 240 hospitals. This approach uses a rule-based system to match providers with Siriraj referral policy. Then, these matched providers’ data are analyzed to calculate its weight value.
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Ramelson, Harley, Amanda Nederlof, Sam Karmiy, Pamela Neri, David Kiernan, Rajlakshmi Krishnamurthy, Adrienne Allen, and David W. Bates. "Closing the loop with an enhanced referral management system." Journal of the American Medical Informatics Association 25, no. 6 (February 17, 2018): 715–21. http://dx.doi.org/10.1093/jamia/ocy004.
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Abstract Objective To evaluate the impact of a referral manager tool on primary care practices. Materials and Methods We evaluated a referral manager module in a locally developed electronic health record (EHR) that was enhanced to improve the referral management process in primary care practices. Baseline (n = 61) and follow-up (n = 35) provider and staff surveys focused on the ease of performing various steps in the referral process, confidence in completing those steps, and user satisfaction. Additional metrics were calculated that focused on completed specialist visits, acknowledged notes, and patient communication. Results Of 1341 referrals that were initiated during the course of the study, 76.8% were completed. All the steps of the referral process were easier to accomplish following implementation of the enhanced referral manager module in the EHR. Specifically, tracking the status of an in-network referral became much easier (+1.43 [3.91–2.48] on a 5-point scale, P < .0001). Although we found improvement in the ease of performing out-of-network referrals, there was a greater impact on in-network referrals. Discussion Implementation of an electronic tool developed using user-centered design principles along with adequate staff to monitor and intervene when necessary made it easier for primary care practices to track referrals and to identify if a breakdown in the process occurred. This is especially important for high-priority referrals. Out-of-network referrals continue to present challenges, which may eventually be helped by improving interoperability among EHRs and scheduling systems. Conclusion An enhanced referral manager system can improve referral workflows, leading to enhanced efficiency and patient safety and reduced malpractice risk.
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Petzel, Sue V., Rachel Isaksson Vogel, Jena McNiel, Anna Leininger, Peter A. Argenta, and Melissa A. Geller. "Improving Referral for Genetic Risk Assessment in Ovarian Cancer Using an Electronic Medical Record System." International Journal of Gynecologic Cancer 24, no. 6 (July 2014): 1003–9. http://dx.doi.org/10.1097/igc.0000000000000148.
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ObjectiveWe sought to evaluate an electronic referral form to increase referral for genetic risk assessment of women with newly diagnosed epithelial ovarian cancer.MethodsA form summarizing referral for genetic counseling for women with ovarian cancer was introduced into the electronic medical record allowing gynecologic oncologists to electronically submit a request for genetic services. Analysis compared patient and provider characteristics for women newly diagnosed with ovarian, fallopian tube, and primary peritoneal cancer referred 1 year before and after introducing the form. All patients were seen in a single fee-for-service university-based cancer center clinic.ResultsThere were 86 newly diagnosed ovarian cancer patients seen before and 83 seen after the introduction of the electronic referral form. Most lived in the metropolitan area and had stage III to IV disease, serous histology, a documented family history, and a treating oncologist who was less than 10 years from completion of fellowship. Postintervention referral rates increased from 17% to 30% (P = 0.053). Factors best predicting referral were whether the patient was seen after the intervention (P = 0.009), resided in the metropolitan area (P = 0.006), and had been identified as at high hereditary risk (P < 0.0001). Sixty percent of the referred patients participated in counseling. There were no differences in baseline characteristics of the referred patients before and after the intervention.ConclusionsReferral rates increased with the introduction of an electronic medical record referral form suggesting that streamlining the physician referral process might be effective at increasing referrals for cancer genetic risk assessment.
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Kline, Teri A., and Donald R. Self. "The Social System Referral Sources and Prevention Referral." Health Marketing Quarterly 7, no. 3-4 (August 3, 1990): 83–94. http://dx.doi.org/10.1300/j026v07n03_07.
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White, S., K. J. Day, Y. Gu, M. Pollock, and J. Warren. "Introduction of Electronic Referral from Community Associated with More Timely Review by Secondary Services." Applied Clinical Informatics 02, no. 04 (2011): 546–64. http://dx.doi.org/10.4338/aci-2011-06-ra-0039.
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SummaryBackground: Electronic referral (eReferral) from community into public secondary healthcare services was introduced to 30 referring general medical practices and 28 hospital based services in late 2007.Objectives: To measure the extent of uptake of eReferral and its association with changes in referral processing.Methods: Analysis of transactional data from the eReferral message service and the patient information management system of the affected hospital; interview of clinical, operational and management stakeholders.Results: eReferral use rose steadily to 1000 transactions per month in 2008, thereafter showing moderate growth to 1200 per month in 2010. Rate of eReferral from the community in 2010 is estimated at 56% of total referrals to the hospital from general practice, and as 71% of referrals from those having done at least one referral electronically. Referral latency from letter date to hospital triage improves significantly from 2007 to 2009 (p<0.001), from a paper referral median of 8 days (inter-quartile range, IQR: 4–14) in 2007 to an eReferral median of 5 days (IQR: 2–9) and paper referral median of 6 days (IQR: 2–12) in 2009. Specialists upgrade the referrer-assigned eReferral priority in 19.2% of cases and downgrade it 18.6% of the time. Clinical users appreciate improvement of referral visibility (status and content access); however, both general practitioners and specialists point out system usability issues.Discussion: With eReferrals, a referral’s status can be checked, and its content read, by any authorized user at any time. The period of eReferral uptake was associated with significant speed-up in referral processing without changes in staffing levels. The eReferral system provides a foundation for further innovation in the community-secondary interface, such as electronic decision support and shared care planning systems.Conclusions: We observed substantial rapid voluntary uptake of eReferrals associated with faster, more reliable and more transparent referral processing.
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Alkhazrajy, Lujain Anwar. "Quality of Primary Care Center Referral Letters and Feedback Reports among Sample of PHCCs in Baghdad /Al-Rusafa Health Directorate During2015." AL-Kindy College Medical Journal 13, no. 1 (October 31, 2019): 1–7. http://dx.doi.org/10.47723/kcmj.v13i1.114.
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Background:The referral system constitutes a key element of health system. Effective referral system between different levels of health care delivery represents a cornerstone in addressing patients’ health needs.
Objectives:To assess the referral system Baghdad/ Al-Rusafa Health Directorate by evaluation the referral pattern and identify the quality of the referral letters and feedback reports.
Type of the study: This cross-sectional study .
Methodology : It was conducted in5PHCC in from 1st July 2015 - 31st December 2015 at Bagdad/Al-Rusafa health directorate. The study population (sampled population) included all referrals in six months. Data were entered and analyzed by using the statistical package for social science (SPSS) software version 17 for windows .
Results: The referral rate was 2.85% .The variables of the referral letter (such as age, gender of the referred patient)were present, while the indication for referral(3.3%), result of investigation done in PHCC (4.67%), initial diagnosis (5.86%), however, the name of physician and signature were not mentioned or specified in 70% of the referral letters. The rate of feedback reports received by PHCCs was 19% of total number of referrals to the hospitals. The referral rate was (2.8%) from total number of patients seen in PHCCs.However, the quality of referral letters and feedback reports was poor in 69.5% and 78.5% respectively.
Conclusion: In this study there was a low referral percentage and low feedback report in five PHCCs of Baghdad/ Al-Rusafa health directorate compared to international literature.The quality of referral letters and feedback reports is poor and contained inadequate information and lacking important and relevant items in majority of referral needs to be improved
Key words: Referral ,Feedback report , primary health care centers(PHCCs)
Background:The referral system constitutes a key element of health system. Effective referral system between different levels of health care delivery represents a cornerstone in addressing patients’ health needs.
Objectives:To assess the referral system Baghdad/ Al-Rusafa Health Directorate by evaluation the referral pattern and identify the quality of the referral letters and feedback reports.
Type of the study: This cross-sectional study .
Methodology : It was conducted in5PHCC in from 1st July 2015 - 31st December 2015 at Bagdad/Al-Rusafa health directorate. The study population (sampled population) included all referrals in six months. Data were entered and analyzed by using the statistical package for social science (SPSS) software version 17 for windows .
Results: The referral rate was 2.85% .The variables of the referral letter (such as age, gender of the referred patient)were present, while the indication for referral(3.3%), result of investigation done in PHCC (4.67%), initial diagnosis (5.86%), however, the name of physician and signature were not mentioned or specified in 70% of the referral letters. The rate of feedback reports received by PHCCs was 19% of total number of referrals to the hospitals. The referral rate was (2.8%) from total number of patients seen in PHCCs.However, the quality of referral letters and feedback reports was poor in 69.5% and 78.5% respectively.
Conclusion: In this study there was a low referral percentage and low feedback report in five PHCCs of Baghdad/ Al-Rusafa health directorate compared to international literature.The quality of referral letters and feedback reports is poor and contained inadequate information and lacking important and relevant items in majority of referral needs to be improved
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Pirruccello, James P., Kathleen C. Traynor, Pradeep Natarajan, Carol Brown, Michael K. Hidrue, Kenneth A. Rosenfield, Sekar Kathiresan, and Jason H. Wasfy. "An electronic cardiac rehabilitation referral system increases cardiac rehabilitation referrals." Coronary Artery Disease 28, no. 4 (June 2017): 342–45. http://dx.doi.org/10.1097/mca.0000000000000491.
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Wilson, Aubrey. "ACTIVATING THE REFERRAL SYSTEM." Property Management 6, no. 3 (March 1988): 209–14. http://dx.doi.org/10.1108/eb006693.
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Carroll, Áine, Paul Mattison, and Catherine Comiskey. "An Audit of a New System of Self–Referral in the Management of Multiple Sclerosis." International Journal of MS Care 4, no. 1 (March 1, 2002): 10–16. http://dx.doi.org/10.7224/1537-2073-4.1.10.
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A random sample of the referral notes of 35 multiple sclerosis patients experiencing relapse and referred via the current general practitioner (GP) system was reviewed. The time between receipt of the referral and assessment/admission (lead time) was examined. The mean value was obtained and a self referral system was initiated and monitored for a period of five months. The mean referral times were compared. The patients' disability status before and after treatment was measured using the Expanded Disability Status Scale (EDSS) and Functional Independence Measure (FIM), and we invited the patients' opinions about the self-referral system. The goals of the newly implemented self-referral system were to reduce lead time to less than 6.5 days, improve patient disability, and avoid inappropriate referral; the new system was also to be “user friendly.” The new system reduced referral times by a statistically significant amount (P = 0.0016). There was a significant objective improvement in patients' disability as measured by the EDSS and FIM scores (P = 0.031 and P = 0.04, respectively). There was a subjective improvement, and patients expressed a preference for the new system. There were no inappropriate referrals. These findings suggest that the self-referral system is efficient and effective and should be further evaluated. (Int J MS Care. 2002; 4: 10–12)
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Coulthard, P., I. Kazakou, R. Koran, and H. V. Worthington. "Referral patterns and the referral system for oral surgery care. Part 2: the referral system and telemedicine." British Dental Journal 188, no. 7 (April 2000): 388–91. http://dx.doi.org/10.1038/sj.bdj.4800491.
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Coulthard, P., I. Kazakou, R. Koran, and P. Coulthard. "Referral patterns and the referral system for oral surgery care. Part 2: the referral system and telemedicine." British Dental Journal 188, no. 07 (April 8, 2000): 388–91. http://dx.doi.org/10.1038/sj.bdj.4800491a.
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Wright, Ellen, York Hagmayer, and Irene Grayson. "An evidence-based referral management system: insights from a pilot study." Primary Health Care Research & Development 16, no. 04 (October 17, 2014): 407–14. http://dx.doi.org/10.1017/s1463423614000395.
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ObjectivesImproving the informational quality of referrals from primary to secondary care and appropriately re-directing referrals is an important goal of clinical commissioning groups in England. Based on the available empirical evidence, a referral management and booking service that combined referral guidelines, online referral templates and administrative and clinical triage, was developed by a primary care trust in southeast London.MethodsA pilot study of 13 out of 46 practices in the trust was conducted using a mixed methods approach. Referral numbers were investigated by analysing changes in practices’ rates of first outpatient attendances in secondary care. Informational referral quality was assessed by analysing triage outcomes. Semi-structured interviews were used to inquire about practices’ evaluation of the new system. Structured telephone interviews were conducted to assess patients’ satisfaction.ResultsOverall rates of first outpatient attendances declined more strongly for pilot practices than controls. The number of referrals challenged for being incomplete or having insufficient clinical information decreased. The rate of referrals challenged by clinical triage for not conforming to referral guidelines was well below the rate of inappropriate referrals published in the literature. Interviews with practices revealed a number of themes and a broad range of attitudes. Patients were highly satisfied.DiscussionFindings provided favourable evidence for the effectiveness of the new referral management system. They were, however, preliminary. If referrals into secondary care continued to be reduced on a long-term basis, the system would be cost effective despite the time and effort required for clinical triage.
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Fernández-Méndez, Rocío, Mei Yin Wong, Rebecca J. Rastall, Samuel Rebollo-Díaz, Ingela Oberg, Stephen J. Price, and Alexis J. Joannides. "Improvement of the Efficiency and Completeness of Neuro-Oncology Patient Referrals to a Tertiary Center Through the Implementation of an Electronic Referral System: Retrospective Cohort Study." Journal of Medical Internet Research 22, no. 3 (March 5, 2020): e15002. http://dx.doi.org/10.2196/15002.
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Background Quality referrals to specialist care are key for prompt, optimal decisions about the management of patients with brain tumors. Objective This study aimed to determine the impact of introducing a Web-based, electronic referral (eReferral) system to a specialized neuro-oncology center, using a service-developed proforma, in terms of waiting times and information completeness. Methods We carried out a retrospective cohort study based on the review of medical records of referred adult patients, excluding follow-ups. Primary outcome measures were durations of three key phases within the referral pathway and completion rates of six referral fields. Results A total of 248 patients were referred to the specialist center during the study period. Median (IQR) diagnostic imaging to referral intervals were 3 (1-5) days with eReferrals, and 9 (4-19), 19 (14-49), and 8 (4-23) days with paper proforma, paper letter, and internal referrals, respectively (P<.001). Median (IQR) referral to multidisciplinary team decision intervals were 3 (2-7), 2 (1-3), 8 (2-24), and 3 (2-6) days respectively (P=.01). For patients having surgery, median (IQR) diagnostic imaging to surgery intervals were 28 (21-41), 34 (27-51), 104 (69-143), and 32 (15-89) days, respectively (P<.001). Proportions of complete fields differed significantly by referral type in all study fields (all with Ps <.001) except for details of presentation, which were present in all referrals. All study fields were always present in eReferrals, as these are compulsory for referral submission. Depending on the data field, level of completeness in the remaining referral types ranged within 69% (65/94) to 87% (82/94), 15% (3/20) to 65% (13/20), and 22% (8/41) to 63% (26/41) in paper proforma, paper letter, and internal referrals, respectively. Conclusions An electronic, Web-based, service-developed specific proforma for neuro-oncology referrals performs significantly better, with shorter waiting times and greater completeness of information than other referral types. A wider application of eReferrals is an important first step to streamlining specialist care pathways and providing excellent care. International Registered Report Identifier (IRRID) RR2-10.2196/10.2196/15002
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Feti Novia Sari, Zulfendri, and Sri Rahayu Sanusi. "Referral Demand of Patients in Pantai Cermin Public Health Center Langkat." Britain International of Humanities and Social Sciences (BIoHS) Journal 2, no. 1 (February 29, 2020): 314–20. http://dx.doi.org/10.33258/biohs.v2i1.194.
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In 2017, the number of referrals issued by Pantai Cermin health center to Langkat District Hospital was 17.7% and the highest number in Langkat District. Referral cases more than 10% will increase hospital burden. This study aims to describe of referral cases at Pantai Cermin Health Center, Langkat. Aspect of referral type given 5 informants asked for referral to an internist, 2 informants asked for obstetricians, and one informant asked for referral to opthalmologist. Regarding who provided the referral, 6 informants stated that the referral was given by the doctor, and 2 informants stated that the referral was given by the midwife. In addition, the reason why the referral was given, 7 informants stated that the referral was given because the informant asked to be referred, and 1 informant stated that the referral was given because the equipment was not available at the public health center. Based on the results, it is recommended to pantai cermin health center to providing referral services in accordance with the applicable regulations and regularly monitoring of implementation of referrals system, and socialize to the community that referrals should be given according to the patient's medical need.
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Aggarwal, Neelam, Rimpi Singla, Lakhbir Dhaliwal, and Vanita Suri. "Audit of Emergency Obstetric Referrals- A Pilot Study From Tertiary Care Centre of North India." Bangladesh Journal of Obstetrics & Gynaecology 30, no. 1 (November 28, 2016): 25–29. http://dx.doi.org/10.3329/bjog.v30i1.30504.
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Objective (s):The aim of the study was to find out the characteristics of emergency obstetric referrals, to evaluate the lapses in the existing referral system and to suggest the plausible solutions to improve the obstetric health care delivery system in India.Materials and methods: This prospective descriptive study was carried out in the Department of Obstertrics and Gynaecology PGIMER Chandigarh India from September 2012 to December 2012.All the obstetric emergency referrals to our institute, a tertiary care centre in North India were critically reviewed for reason for referral, adequacy of care provided before referral, lapses in management, factors behind suboptimal care and remedial measures are suggested.Results: There were 232 emergency referrals available for analysis. Of these 76% patients were referred directly to the institute, the highest level in referral chain in the region. Mean age was 26yrs, 28.6% of the patients were illiterate. In 75.5% of cases, the management of obstetric emergency before referral was suboptimal or poor. In 16% of cases patient failed to seek medical help timely despite emergency. In 40% of cases there was undue delay in referring or failure to provide even the basic care. Anticipated premature delivery and hypertensive disorders of pregnancy were the most common diagnosis at referral.Conclusion: Results from this pilot study shows that in spite of the most extensive health care infrastructure and so- called hierarchal referral system, there is gross inadequacy in referral system in India.Bangladesh J Obstet Gynaecol, 2015; Vol. 30(1) : 25-29
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Khou, Vincent, Angelica Ly, Lindsay Moore, Maria Markoulli, Michael Kalloniatis, Michael Yapp, Michael Hennessy, and Barbara Zangerl. "Review of referrals reveal the impact of referral content on the triage and management of ophthalmology wait lists." BMJ Open 11, no. 9 (September 2021): e047246. http://dx.doi.org/10.1136/bmjopen-2020-047246.
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ObjectivesMany chronic eye conditions are managed within public hospital ophthalmology clinics resulting in encumbered wait lists. Integrated care schemes can increase system capacity. In order to direct implementation of a public hospital-based integrated eye care model, this study aims to evaluate the quality of referrals for new patients through information content, assess triage decisions of newly referred patients and evaluate the consistency of referral content for new patients referred multiple times.DesignA retrospective and prospective review of all referral forms for new patients referred to a public hospital ophthalmology clinic between January 2016 and September 2017, and September 2017 and August 2018, respectively.SettingA referral-only public hospital ophthalmology clinic in metropolitan Sydney, Australia.Participants418 new patients on existing non-urgent wait lists waiting to be allocated an initial appointment, and 528 patients who were newly referred.Primary and secondary outcome measuresThe primary outcome was the information content of referrals for new patients. The secondary outcomes were triage outcomes for new incoming referrals, and the number of new patients with multiple referrals.ResultsOf the wait-listed referrals, 0.2% were complete in referral content compared with 9.8% of new incoming referrals (p<0.001). Of new incoming referrals, 56.7% were triaged to a non-urgent clinic. Multiple referrals were received for 49 patients, with no change in the amount of referral content.ConclusionsMost referrals were incomplete in content, leading to triage based on limited clinical information. Some new patients were referred multiple times with their second referral containing a similar amount of content as their first. Lengthy wait lists could be prevented by improving administrative processes and communication between the referral centre and referrers. The future implementation of an integrated eye care model at the study setting could sustainably cut wait lists for patients with chronic eye conditions.
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Chandrayan, Piyusha, Rohit K. Merawat, and Usha P. Parekh. "Significance of timely reference on maternal morbidity and mortality." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 10 (September 26, 2018): 3985. http://dx.doi.org/10.18203/2320-1770.ijrcog20184116.
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Background: The objective is to evaluate the effectiveness of the timely maternal referral system to a tertiary care centre in reducing maternal morbidity and mortality. Well known causes of maternal mortality are delays at three levels: in seeking care, in referring/reaching health facility in time and in receiving adequate treatment. In this study, authors have made an attempt to focus mainly on the referral system in improving maternal morbidity and mortality.Methods: This was an observational study, conducted at Dhiraj General Hospital, a rural tertiary health care facility, affiliated to SBKSMC and RC located in Waghodia district,16 kms away from the Vadodara city. It covers an area of around 7,550 sq kms of rural areas. All the patients referred from any centre and admitted to emergency obstetrical ward were included under the study within the study time period.Results: The total incidence of referred patients in this study accounted for 7.49%. 70% of the patients under study were unbooked. 65% of the referrals were multigravida. 35% of the patients were of age group 24-29 yrs. Hemorrhage, accounting 39% was the most common cause of referral. The bulk of referrals,70% were within the 50km circumference. 65% of present referred cases reached within 5 hours from the referring centre due to timely referral and easy accessibility of the transport system like - availability of 108.Conclusions: Timely referrals of women have significantly reduced the maternal morbidity and mortality as patients from remote area can avail tertiary medical health facilities. A proper referral letter with primary care from the referring centre can further enhance the functioning of this system.
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Khanna, Niharika, Elena Klyushnenkova, Vibha Rao, Neil Siegel, and Sara Wolfe. "Electronic referrals to the tobacco Quitline: implementation strategies in a large health system to optimize delivery of tobacco cessation to patients." Translational Behavioral Medicine 11, no. 5 (January 7, 2021): 1107–14. http://dx.doi.org/10.1093/tbm/ibaa094.
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Abstract Electronic referrals provide an efficient solution for clinicians to connect patients to free tobacco cessation services, such as the tobacco Quitline. However, strategic planning is necessary for the successful adoption of this method across the health care system. The purpose of this study was to develop an implementation strategy for electronic referrals to the tobacco Quitline in a large health system. A clinical decision support tool created a closed-loop e-referral pathway between the electronic health record system and the Quitline. Multilevel strategies were developed to implement the e-referral process across the entire health system, including leadership buy-in, Epic tip sheets, newsletters, training for practice champions and staff, physician educator, patient-focused advertisements, and video clips distribution by the Maryland Department of Health Center for Tobacco Prevention and Control. The implementation of a system-wide e-referral pathway for tobacco cessation involved continuous clinician education and training, systematic quality control, and engaging “champion” clinicians. Postimplementation data analysis revealed that 1,790 e-referrals were received by the Quitline in 2018–2019, of which 18% accepted follow-up services, 18% declined, and 64% were not reached after multiple attempts. Among 322 patients who accepted Quitline services, 55% requested nicotine replacement therapy. Overall, 282 clinicians referred patients, including 107 primary care physicians and 175 specialists; 62 clinicians e-referred 72% patients, thereby emerging as “tobacco champions.” The e-referral process is an efficient method for tobacco users to receive a cessation referral from clinicians. Sustainability can be achieved through leadership buy-in, physician ease of use, patient motivation, information technology supports, and reminders.
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Ashton, Elizabeth, Benjamin Smeeton, and Stuart Weatherby. "ONE YEAR RETROSPECTIVE AUDIT OF CNS MALIGNANCY 2 WW REFERRALS." Journal of Neurology, Neurosurgery & Psychiatry 86, no. 11 (October 14, 2015): e4.126-e4. http://dx.doi.org/10.1136/jnnp-2015-312379.37.
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BackgroundSince its introduction in 2000, concerns have been raised about the two week wait (2 WW) referral system for suspected malignancy. Studies have demonstrated poor compliance to guidelines, low detection rates and questioned the time effectiveness of the referral process.MethodAll patients referred under the 2 WW system for suspected CNS malignancy to Derriford Hospital, Plymouth Hospitals NHS trust, over a one-year period were retrospectively audited. Data was gained from clinic letters and radiological imaging. The aims were to determine the number of referrals, their appropriateness and subsequent time taken to outpatient appointment, imaging and final diagnosis.Results103 referrals were made between September 2013 and September 2014 with just 48.5% fulfilling NICE referral guidelines for suspected CNS malignancy. Just three tumours were diagnosed with guidelines identifying all of these. Only 28% of 2 WW referrals received diagnostic imaging and an outpatient appointment within two weeks.ConclusionsUnnecessary referrals are placing strain on the 2 WW system. We suggest that a potential solution is for general practitioners to refer patients for imaging at the same time as they make their neurological 2 WW referral in order to cut down waiting times.
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Mengga, Beatrix, and Prasetyo B. "Characteristics and Maternal Neonatal Outcomes Analysis of Referral Cases at Lakipadada Regional Public Hospital, Tana Toraja on Period March-August 2019." International Islamic Medical Journal 1, no. 2 (September 1, 2020): 89–94. http://dx.doi.org/10.33086/iimj.v1i2.1627.
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Background: Referral system is often noticed as an obstacle for getting health services because it requires more time, higher cost, health services that are not appropriate with competence, patients are accumulated in several health care facilities that can reduce satisfaction of the patient. The implementation of tiered referral system also experiences obstacles that related to geographical factors, distance, transportation and limitations of health services, therefore it is necessary to have an assessment how the characteristics and outcomes of obstetric referral cases in an area. Objective: To identify the charactheristics of obstetric referral cases and maternal – neonatal outcomes from referral cases at Lakipadada Regional Public Hospital on period March – August 2019. Methods: : This study was a retrospective analysis study using descriptive methods of medical record data in obstetric patients at Lakipadada Regional Public Hospital, Tana Toraja on period March - August 2019. Results: The total number of obstetric referral cases is 218 cases, which 154 cases were referred from inside Tana Toraja itself (the most referrals were from private clinics), 64 cases were referred from outside Tana Toraja (the most referrals were from Enrekang District) with the most referral indication was Prolonged Latent Phase. Vaginal delivery was performed in 86 total of cases, caesarean section was 117 total of cases. Conclusion: In the referral cases, there was still a delay in referring patients which on period March-August 2019, there were 2 maternal death, 2 infant deaths and 5 IUFD.
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Wilberforce, Mark, Jane Hughes, Paul Clarkson, David Whyte, Helen Chester, Sue Davies, and David Challis. "An electronic referral system supporting integrated hospital discharge." Journal of Integrated Care 25, no. 2 (April 18, 2017): 99–109. http://dx.doi.org/10.1108/jica-09-2016-0034.
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Purpose The purpose of this paper is to evaluate the implementation and potential value of an electronic referral system to improve integrated discharge planning for hospitalised older adults with complex care needs. This new technology formed part of the “Common Assessment Framework for Adults” policy in England. Design/methodology/approach Mixed methods were undertaken as part of a case study approach within an acute hospital in the North West of England. First, qualitative interviews were undertaken with practitioners to explore early experiences using the new technology. Second, routinely collected administrative data were analysed, comparing referrals made using the new technology and those made through the usual paper-based process. Findings Qualitative interviews found that an electronic discharge system has, in principle, the potential to improve the efficiency and suitability of integrated care planning. However, the implementation proved fragile to decisions taken elsewhere in the local care system, meaning its scope was severely curtailed in practice. Several “socio-technical” issues were identified, including the loss of valuable face-to-face communication by replacing manual with electronic referrals. Research limitations/implications The small number of patients referred during the implementation phase meant that patient outcomes could not be definitively judged. Research into the longer-term implications and value of electronic referral systems is needed. Originality/value There is concern that attempts to integrate health and social care are stymied by incompatible systems for recording service user information. This research explores a novel attempt to share assessment information and improve support planning across health and social care boundaries.
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Muttuvelu, Danson Vasanthan, Heidi Buchholt, Mads Nygaard, Marie Louise Roed Rasmussen, and Dawn Sim. "Danish teleophthalmology platform reduces optometry referrals into the national eye care system." BMJ Open Ophthalmology 6, no. 1 (March 2021): e000671. http://dx.doi.org/10.1136/bmjophth-2020-000671.
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ObjectiveThe purpose of this study was to evaluate the stratification of follow-up and referral pathways after implementation of a systematic cloud-based electronic-referral teleophthalmological service for optometry-initiated ocular posterior segment disease referrals to the Danish national eye care system.Methods and AnalysisA retrospective cohort study was conducted in the period from 1 August 2018 to 31 July 2019. Patients with suspected ocular posterior segment disease reviewed by the telemedical ophthalmology service were included. The service stratified patients into the categories: no need for follow-up, follow-up by optometrist, follow-up by the telemedical service and referral to the national Danish eye care service.ResultsFrom a pool of 386 361 customers, 9938 patients were enrolled into this study. 19.5% of all patients were referred to the Danish national eye care system, while 80.5% of the patients in the telemedical service were not, in the period from 1 August 2018 to 31 July 2019. 14.4% of the optometrist referrals did not need any follow-up, while a majority of 66.1% needed some follow-up either by the optometrist themselves or within the telemedical service.ConclusionOptometrist posterior segment disease referrals can be considerably reduced with a risk stratified approach and optimal use of technology. New models can improve and streamline the healthcare system.
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Poyah, Penelope S., and Tabassum Ata Quraishi. "The Impact of a New Triage and Booking System on Renal Clinic Wait Times." Canadian Journal of Kidney Health and Disease 7 (January 2020): 205435812092414. http://dx.doi.org/10.1177/2054358120924140.
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Background: Prolonged wait times are known barriers to accessing nephrology care for patients needing more urgent specialist services. Improved process and standardized triage systems are known to minimize wait times of urgent or semi-urgent care in health care disciplines. In Central Zone (CZ) renal clinic, mean wait times for urgent (P1) and semi-urgent (P2) referrals were prolonged before 2014. We also observed prolonged wait times for elective (P3-P5) categories. Improving wait times was identified as an access to care quality improvement focus in CZ renal clinic of the Nova Scotia Health Authority (NSHA). Objectives: To describe our new referral process and new triage system, and to examine their effect on number of referrals wait-listed and mean wait times. Design: A quasi-experimental design was used. Setting: Halifax, Nova Scotia, Canada. Participants: Patients referred to Central Zone Renal Clinic between 2012 and 2018. Measurements: A time series of referral counts and wait times for each triage category were measured before our interventions and after implementing our interventions. Methods: We reviewed our referral processes to identify gaps leading to prolonged wait times. On January 1, 2014, we implemented new administrative procedures: pretriage (standardized referral information form and staff training), triage (standardized clinic intake criteria and new triage guidelines), posttriage (protecting clinic spots for urgent and semi-urgent referrals, wait-list maintenance, and increasing new referral clinic capacity). Data were collected prospectively. Descriptive analysis on mean wait times was done using run charts. Results: A 33% reduction in total number of referrals wait-listed was observed over 4.5 years after intervention. Descriptive analysis of the urgent and semi-urgent categories (P1 and P2) revealed a significant shift of mean wait times on run charts after the interventions. Target wait time was achieved in 94% of P1 category and 78% of P2 category. Limitations: This type of study design does not exclude confounding variables influencing results. We did not explore stakeholder satisfaction or whether the new referral process presented barriers to resending referrals that had insufficient triage data. The long-term sustainability of adding demand-responsive surge clinics and opportunity cost were not assessed. Our referral process and triage system have not been externally validated and may not be applicable in settings without wait-lists or settings that use electronic, telephone or telemedicine consults. Conclusion: Our selective intake of referrals with adequate triage information and referrals needing nephrology consult as defined by our clinic intake criteria reduced number of referrals wait-listed. We saw improved wait times for urgent and semi-urgent referrals with these categories now falling within target wait times for the vast majority of patients. The work of this improvement initiative continues especially for the lower-risk triage categories. Trial registration: Not applicable as this was a Quality improvement initiative.
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Hershaw, Catherine Maria. "Orthodontic Referrals: Electronic versus Paper." Orthodontic Update 14, no. 2 (April 2, 2021): 69–70. http://dx.doi.org/10.12968/ortu.2021.14.2.69.
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The Cwm Taf Community Dental Service (CDS) has previously used a paper system to refer patients to the orthodontic specialists within the Cwm Taf CDS. However, at the beginning of June 2019, an electronic referral system was introduced. Although electronic referrals have had a minimal effect on the overall waiting time for a patient, there has been an improvement in the efficiency of transfer of orthodontic referrals within the CDS. Electronic referral systems have reduced the number of inappropriate referrals, improved patient confidentiality and maintained an accurate record that is accessible from any of the Cwm Taf CDS clinics. CPD/Clinical Relevance: The article highlights the benefits of an electronic referral system with respect to reducing both inappropriate referrals and waiting times.
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BULUT, Sinan, and Özgür UĞURLUOĞLU. "Referral System in Health Care." Turkiye Klinikleri Journal of Health Sciences 5, no. 1 (2020): 166–82. http://dx.doi.org/10.5336/healthsci.2018-64475.
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Verma, Avadhesh, Ajay Gaur, and Ravi Ambey. "Assessment of existing referral system of newborn in Madhya Pradesh, India." International Journal of Contemporary Pediatrics 6, no. 4 (June 27, 2019): 1466. http://dx.doi.org/10.18203/2349-3291.ijcp20192632.
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Background: Objectives of present study was to assess receiving system of newborns, bed occupancies of referring facilities and receiving facility and assessment of rationality of referrals made by referring facilities to receiving facility leading to congestion at receiving facility. The study was conducted in Department of Pediatrics, Special Newborn Care Unit, Kamla Raja Hospital, Gajra Raja Medical College, Gwalior, Madhya Pradesh.Methods: This study was a prospective observational study which was conducted for a period of one year. Referred newborns fulfilling inclusion criteria were enrolled in study, and their receiving characteristics, bed occupancies of referring facilities and receiving facility, number of rationale and irrational referrals at receiving facility were statistically analysed.Results: Total referred newborns enrolled in the study was 2000. As receiving SNCU, of institute caters not only its nearby places, but also to distant districts of Madhya Pradesh, Rajasthan and Uttar Pradesh. SNCU wise receiving was in order of SNCU Morar (20.60%), Morena (19.40%), Bhind (5.70%), Dholpur (5.35%), Shivpuri (4.40%), Chattarpur (3.10%), Datia (1.20%), Sheopur (0.40%) and Jhansi (0.30%). Referring SNCU wise bed occupancy was in order of SNCU Guna (189.16%), Shivpuri (154%), Morena (72.33%), Bhind (71.63%), Sheopur (69.32%), Morar (64.15%) and Datia (62.11%). Referring SNCU wise case fatality was in order of SNCU Jhansi (100%), Sheopur (100%), Chattarpur (56.45%), Bhind (38.59%), Shivpuri (35.22%), Morena (33.76%), Dholpur (27.10%), Datia (25%), Morar (22.08%).Conclusions: Discordant bed occupancy at referring SNCU and receiving SNCU and low rationality of referrals are reason for congestion at receiving SNCU. Optimum utilization of beds and cordant bed occupancy between referring and receiving SNCU may improve the working conditions in SNCU and newborn outcome. Referral system should be close loop systemwith the provision of Down Referral.
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Fiore, Michael, Rob Adsit, Mark Zehner, Danielle McCarthy, Susan Lundsten, Paul Hartlaub, Todd Mahr, Allison Gorrilla, Amy Skora, and Timothy Baker. "An electronic health record–based interoperable eReferral system to enhance smoking Quitline treatment in primary care." Journal of the American Medical Informatics Association 26, no. 8-9 (May 15, 2019): 778–86. http://dx.doi.org/10.1093/jamia/ocz044.
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Abstract Objective The study sought to determine whether interoperable, electronic health record–based referral (eReferral) produces higher rates of referral and connection to a state tobacco quitline than does fax-based referral, thus addressing low rates of smoking treatment delivery in health care. Materials and Methods Twenty-three primary care clinics from 2 healthcare systems (A and B) in Wisconsin were randomized, unblinded, over 2016-2017, to 2 smoking treatment referral methods: paper-based fax-to-quit (system A =6, system B = 6) or electronic (eReferral; system A = 5, system B = 6). Both methods referred adult patients who smoked to the Wisconsin Tobacco Quitline. A total of 14 636 smokers were seen in the 2 systems (system A: 54.5% women, mean age 48.2 years; system B: 53.8% women, mean age 50.2 years). Results Clinics with eReferral, vs fax-to-quit, referred a higher percentage of adult smokers to the quitline: system A clinic referral rate = 17.9% (95% confidence interval [CI], 17.2%-18.5%) vs 3.8% (95% CI, 3.5%-4.2%) (P < .001); system B clinic referral rate = 18.9% (95% CI, 18.3%-19.6%) vs 5.2% (95% CI, 4.9%-5.6%) (P < .001). Average rates of quitline connection were higher in eReferral than F2Q clinics: system A = 5.4% (95% CI, 5.0%-5.8%) vs 1.3% (95% CI, 1.1%-1.5%) (P < .001); system B = 5.3% (95% CI, 5.0%-5.7%) vs 2.0% (95% CI, 1.8%-2.2%) (P < .001). Discussion Electronic health record–based eReferral provided an effective, closed-loop, interoperable means of referring patients who smoke to telephone quitline services, producing referral rates 3-4 times higher than the current standard of care (fax referral), including especially high rates of referral of underserved individuals. Conclusions eReferral may help address the challenge of providing smokers with treatment for tobacco use during busy primary care visits. ClinicalTrials.gov; No. NCT02735382.
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Senitan, Mohammed, Ali Hassan Alhaiti, James Gillespie, Badar Faiz Alotaibi, and George Binh Lenon. "The Referral System between Primary and Secondary Health Care in Saudi Arabia for Patients with Type 2 Diabetes: A Systematic Review." Journal of Diabetes Research 2017 (2017): 1–8. http://dx.doi.org/10.1155/2017/4183604.
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Background. In Saudi Arabia, the mortality of diabetes is currently reported at 6%. A well-administered referral system is crucial in aiding the management of this disease. Method. A single reviewer employed a systematic approach to searching the literature databases with regard to the question: what are the attributes of referral systems in Saudi Arabia for patients with type 2 diabetes (T2D)? The results were analysed in order to provide recommendations to improve the Saudi health system. Results. Twelve primary studies were identified from a systematic search. Overall, the 12 studies did not clearly mention any of the factors of a good referral system. The referral problems identified by this study included patients’ unnecessary requests for referral, unstructured referral letters, and unclear dissemination guidelines for referral. Conclusions. This research attempted to identify the efficiency of the referral processes that were implemented for patients with T2D. The majority of the included studies were completely silent on the main referral factors for patients. If this review is representative of the referral system in Saudi Arabia, then, in the context of T2D, current referrals are unsafe. Further research on the quality of the referral system, taking into account at least some of the WHO referral guidelines, is required.
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Khwaja, Zohaib, and Brian J. Millar. "An Analysis of Electronic Primary Dental Practice Tooth Wear Referrals." Primary Dental Journal 10, no. 1 (March 2021): 56–62. http://dx.doi.org/10.1177/2050168420980960.
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We evaluated the quality of general dental practitioner (GDP) tooth wear (TW) referrals to secondary care services in Kent, Surrey and Sussex. Prospective consecutive referrals received via an electronic pathway were assessed from 1 June to 30 October 2019. Reasons for referral, patient demographics, quality of referral, opinion of the triaging clinician and outcome were assessed. Of 671 referrals, 32% were for TW. Males were referred more commonly (1.7:1.0). The median age was 52. Patients were more likely to be referred from distant locations than places closer to the referral centre (p<0.001). Only 55% of referrals suggested a cause for the TW, 33% provided a clinical photograph and 1% recorded a tooth wear index of any type. Referring clinicians most commonly cited attrition as reason for referral (p<0.001). Those under 40 years were referred for erosion (p=0.001) and those over 40 years, attrition (p=0.019). The triaging clinician was more likely to allocate a tooth wear score of three for those under 40 years and a score of four for over 40 years (p<0.001). 47% of referrals were rejected. Males and referrals with photographs were more likely to be accepted for treatment (p=0.017 and p<0.001, respectively). There is a high demand for specialist TW services. The number of referrals being rejected has not changed using the electronic referral system. We advocate the inclusion of mandatory fields for completion by GDPs as well as compulsory clinical photographs and tooth wear indices (Smith and Knight Tooth Wear Index or a basic erosive wear examination - BEWE index).
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Doumouras, Aristithes G., Sama Anvari, Ruth Breau, Mehran Anvari, Dennis Hong, and Scott Gmora. "The effect of an online referral system on referrals to bariatric surgery." Surgical Endoscopy 31, no. 12 (April 26, 2017): 5127–34. http://dx.doi.org/10.1007/s00464-017-5578-x.
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Das, Sujata, and Walter P. Bouman. "Direct referrals from social services to community teams for older people with mental illness." Psychiatric Bulletin 32, no. 5 (May 2008): 164–65. http://dx.doi.org/10.1192/pb.bp.107.015883.
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Aims and MethodThe aim of the study was to evaluate the open referral system from social services to a community mental health team (CMHT) for older people. Referral letters from social services to the specialist team were reviewed, as were the case notes.ResultsOf the 40 referrals, 95% (n=38) were accepted by the CMHT. Only 15% (n=6) fulfilled the team's existing referral criteria. The majority of referrals (n=36, 90%) had details of the patient's mental health problems. None of the referrals with memory problems had a cognitive assessment. Of the 38 referrals accepted by the CMHT, 36 were found to be suffering from a mental illness. The open referral system from social services did not increase the total number of annual referrals.Clinical ImplicationsSocial services play an important role in identifying and referring older people with mental illness and ensure a potentially rapid referral route bypassing primary care. The practice of accepting direct referrals from social services should be encouraged and made an integral part of the referral system.
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Mathew, Anup, and KM Desai. "An Audit of Urology Two-Week Wait Referrals in a Large Teaching Hospital in England." Annals of The Royal College of Surgeons of England 91, no. 4 (May 2009): 310–12. http://dx.doi.org/10.1308/003588409x391767.
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INTRODUCTION Two week wait referral guidelines have been published by the UK Department of Health for suspected urological cancers. Concordance to these guidelines is variable. Our objectives were to assess the incidence of urological malignancy and the proportion of inappropriate referrals in the two-week wait pathway. PATIENTS AND METHODS Retrospective audit of all two-week wait referrals to the urology department over 6 months. Inappropriate referrals were those not satisfying the referral criteria, but referred under the two-week wait system. Detection rates were calculated for each referral criterion based on diagnosis obtained from histology, imaging reports and clinic letters. RESULTS Incidence of cancer was 90 of 400 two-week wait referrals (23%). The cancer-detection rate based on reasons for referral ranged from 50 of 122 (41%) for elevated prostate-specific antigen levels to 2 of 56 (4%) for scrotal lumps; 42 (11%) referrals were inappropriate. CONCLUSIONS The overall cancer-detection rate is acceptable. Most inappropriate referrals were for long-standing symptoms and non-specific testicular/scrotal symptoms. The testicular cancer detection rate raises questions about the two-week wait guidelines. Providing general practitioners with fast-track scrotal ultrasound and revising the guideline may reduce the disproportionately high number of patients referred with suspected testicular cancer. Other inappropriate referrals are a cause for concern as they add to the workload of the ‘urgent-referral’ pathway. Urological cancers (those involving the prostate, testis, penis, urethra, bladder, ureters and kidneys) accounted for 15.4% of all new cancers in England, 1 and 12.1% of deaths from cancer, 2 in England and Wales, in 2004. The two-week wait referral guidelines published by the UK Department of Health for suspected urological cancers 3 are summarised in Table 1 . NHS trusts and SHAs are encouraged to carry out clinical audits of suspected cancer referrals to generate further information. 4 There is wide variation among various centres and regions in the concordance of general practitioner (GP) referrals based on these guidelines, and also the rate of cancers detected based on the two-week wait system. [Table: see text] The objectives of this audit were to calculate: (i) the rate of detection of cancers among the two-week wait referrals; (ii) the rate of detection of cancers based on the reason for referral; and (iii) the proportion of inappropriate referrals.
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Paidi, Sirisha, and Aashritha Thonangi. "Region wise referrals to a tertiary care centre: a retrospective analysis." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 12 (November 26, 2019): 4678. http://dx.doi.org/10.18203/2320-1770.ijrcog20195201.
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Background: Emergency obstetric care in health care requires a linked referral system to be effective in reducing maternal morbidity and mortality. This review is aimed at summarizing the proportion of referrals from urban, rural and tribal areas of surrounding districts to tertiary care centre, King George Hospital, Visakhapatnam for a 6 month period; from May 2018 to October 2018.Methods: Retrospective study done at a tertiary care teaching hospital, including 3157 cases referred from the surrounding urban, rural and tribal areas.Results: Out of the 3157 referred cases, most of them (1658) were from rural areas, 1030 from urban and 469 from tribal areas. Referrals done in view of post caesarean pregnancies were more in urban and rural areas whereas more preeclampsia and anaemia cases were referred from tribal areas. Various indications of referral are documented. Majority of them were unbooked cases.Conclusions: Specific guidelines regarding whom to refer, how to refer and when to refer would be helpful in making timely referral. These would also help to decrease the burden on the tertiary care centers which deal with a huge caseloads in spite of limited infrastructure and manpower. Adequate attention and better care can be given to complicated cases if the total case load is reduced. Stringent documentation in referral slip and better co-ordination are required for a strong health care system.
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Soeripto, Nadia Damayanti. "THE IMPLEMENTATION OF CLINICAL PROCEDURES IN THE VERTICAL REFERRAL SYSTEM IN A PRIMARY HEALTHCARE CENTER." Jurnal Administrasi Kesehatan Indonesia 7, no. 1 (June 13, 2019): 73. http://dx.doi.org/10.20473/jaki.v7i1.2019.73-80.
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Background: A referral system in the era of National Health Insurance starts from first-level primary health facility. The high number of referral in one of primary healthcare centers in Surabaya indicates that the implementation of the vertical referral system has not gone well.Aim: To determine the conformity of the vertical referral system to the clinical procedures at the general outpatient clinics of the the primary healthcare center based on the National Referral System Guidelines.Methods: This study was an observational descriptive study and used implementation research method, which conducted in August 2018. This study was conducted in one of primary healthcare centers in Surabaya. This study used triangulated data, such as the review of reference documents, interviews with referral officers, and direct observation.Results: Out of 7 regulations in the clinical procedures of referral system according to the National Referral System Guidelines, only 2 regulations were not run by the at the general outpatient clinics of the primary healthcare center. For example, patients being referred did not come to the primary healthcare center on their own instead of requesting their family to come. Also, the doctors in the primary healthcare center referred the patients by themselves. However, according to the guidlines, before referring patients, the doctors should contact the referred health facilities.Conclusion: The implementation of clinical procedures in the vertical referral system in the primary healthcare center in Surabaya is broadly in accordance with the existing regulations and guidelines. However, it is necessary to do some improvement. It is recommended that they should re-contact the referral health facility before referring the patients to improve the quality of communication and provide more education to the patients’ family so that they bring the patients to do check-up when the the referral is extended. Keywords: Clinical procedure, Primary healthcare center, Vertical referral system.
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Amoakoh-Coleman, Mary, Evelyn Ansah, Kerstin Klipstein-Grobusch, and Daniel Arhinful. "Completeness of obstetric referral letters/notes from subdistrict to district level in three rural districts in Greater Accra region of Ghana: an implementation research using mixed methods." BMJ Open 9, no. 9 (September 2019): e029785. http://dx.doi.org/10.1136/bmjopen-2019-029785.
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ObjectiveTo assess the completeness of obstetric referral letters/notes at the district level of healthcare.DesignAn implementation research within three districts in Greater Accra region using mixed methods. During baseline and intervention phases, referral processes for all obstetric referrals from lower level facilities seen at the district hospitals were documented including indications for referrals, availability and completeness of referral notes/forms. An assessment of before and after intervention availability and completeness of referral forms was carried out. Focus group discussions, non-participant observations and in-depth interviews with health workers and pregnant women were conducted for qualitative data.SettingThree (3) districts in the Greater Accra region of Ghana.ParticipantsPregnant women referred from lower levels of care to and seen at the district hospital, health workers within the three districts and pregnant women attending antenatal clinic in the district and their family members or spouses.InterventionAn enhanced interfacility referral communication system consisting of training, provision of communication tools for facilities, formation of hospital referral teams and strengthening feedback mechanisms.OutcomeCompleteness of obstetric referral letters/notes.ResultsProportion of obstetric referrals with referral notes improved from 27.2% to 44.3% from the baseline to intervention period. Mean completeness (95% CI) of all forms was 71.3% (64.1% to 78.5%) for the study period, improving from 70.7% (60.4% to 80.9%) to 71.9% (61.1% to 82.7%) from baseline to intervention periods. Health workers reported they do not always provide referral notes and that most referral notes are not completely filled due to various reasons.ConclusionsMost obstetric referrals did not have referral notes. The few notes provided were not completely filled. Interventions such as training of health workers, regular review of referral processes and use of electronic records can help improve both the provision of and completeness of the referral notes.
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Beyene, Habtamu, Dejene Hailu Kassa, Henok Dangiso Tadele, Lars Persson, Atkure Defar, and Della Berhanu. "Factors associated with the referral of children with severe illnesses at primary care level in Ethiopia: a cross-sectional study." BMJ Open 11, no. 6 (June 2021): e047640. http://dx.doi.org/10.1136/bmjopen-2020-047640.
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Context and objectiveEthiopia’s primary care has a weak referral system for sick children. We aimed to identify health post and child factors associated with referrals of sick children 0–59 months of age and evaluate the healthcare providers’ adherence to referral guidelines.DesignA cross-sectional facility-based survey.SettingThis study included data from 165 health posts in 52 districts in four Ethiopian regions collected from December 2018 to February 2019. The data included interviews with health extension workers, assessment of health post preparedness, recording of global positioning system (GPS)-coordinates of the health post and the referral health centre, and reviewing registers of sick children treated during the last 3 months at the health posts. We analysed the association between the sick child’s characteristics, health post preparedness and distance to the health centre with referral of sick children by multivariable logistic regressions.Outcome measureReferral to the nearest health centre of sick young infants aged 0–59 days and sick children 2–59 months.ResultsThe health extension workers referred 39/229 (17%) of the sick young infants and 78/1123 (7%) of the older children to the next level of care. Only 18 (37%) sick young infants and 22 (50%) 2–59 months children that deserved urgent referral according to guidelines were referred. The leading causes of referral were possible serious bacterial infection and pneumonia. Those being classified as a severe disease were referred more frequently. The availability of basic amenities (adjusted OR, AOR=0.38, 95% CI 0.15 to 0.96), amoxicillin (AOR=0.41, 95% CI 0.19 to 0.88) and rapid diagnostic test (AOR=0.18, 95% CI 0.07 to 0.46) were associated with less referral in the older age group.ConclusionFew children with severe illness were referred from health posts to health centres. Improving the health posts’ medicine and diagnostic supplies may enhance adherence to referral guidelines and ultimately reduce child mortality.
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Khoja, Tawfik A. M., Ali M. Al Shehri, Abdul Aziz F. Abdul Aziz, and Khwaja M. S. Aziz. "Patterns of referral from health centres to hospitals in Riyadh region." Eastern Mediterranean Health Journal 3, no. 2 (March 15, 1997): 236–43. http://dx.doi.org/10.26719/1997.3.2.236.
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Patterns of attendance and referrals in hospitals and health centres in Riyadh region, Saudi Arabia, studied before and after implementing a referral system showed a 40.6% total decrease in patients attending hospital outpatient clinics;an 11.9% increase in patients attending primary health centres;a 19.2% increase in referrals;a 33.2% increase in patients attending emergency departments;and a 17.3% increase in inpatients. It is clear that the referral system has, and will have, an impact on primary and secondary health care services. In order to optimize positive and minimize negative aspects of this impact, communication between primary health centres and hospitals should be of high standard. Regular reviews and studies of referral systems are recommended
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Li, Ying, Xiao Jing Yi, and Yu De Geng. "Social-Security-System-Based Two-Way Referral Management Information System." Applied Mechanics and Materials 121-126 (October 2011): 2248–52. http://dx.doi.org/10.4028/www.scientific.net/amm.121-126.2248.
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The two-way referral system comes into being in China with further development of community medical service. Based on investigation and survey of two-way referral system, the paper proposes the social security based two-way referral MIS, by way of the social security network linking the hospital and the community. Based on system feasibility, the paper makes functional structure overall design and function model design. The two-way referral MIS formulated in the paper can lower the two-way referral cost and help increase visiting rate and improve medical care in the community medical institution.
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Hashimoto, Yoichiro, Yasuyuki Itoh, Tadashi Terasaki, Toshiro Yonehara, Makoto Tokunaga, and Susumu Watanabe. "Referral system for stroke in Kumamoto." Nosotchu 36, no. 2 (2014): 99–104. http://dx.doi.org/10.3995/jstroke.36.99.
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Poudel, Krishna Kanta, Deborah Sims, Dianne Morris, Prakash Raj Neupane, Anjani Kumar Jha, Nirmal Lamichhane, Ganga Sapkota, et al. "Cancer Cases Referral system in Nepal." Nepal Journal of Epidemiology 8, no. 4 (December 31, 2018): 748–52. http://dx.doi.org/10.3126/nje.v8i4.23877.
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The burden of cancer is estimated to be increasing in Nepal, whilst the country lacks national established guidelines or protocols for referral of cancer cases. Cancer patients are presenting many different health facilities throughout the country. In rural areas almost all cancer patients have their first diagnosis when visiting a health assistant or nurse at their nearest primary health care delivery service. If cancer is suspected, health care assistants or nurses will refer the patient to a medical doctor at the primary health centre, or refer the patient directly to the cancer treatment centre or oncology department of the closest hospital. Patients from urban areas will usually be seen for the first time by a medical doctor initially and then referred to either the cancer treatment centre or oncology department of the hospital. Both in rural and urban areas the referral for treatment is determined by both the patients’ capacity to pay for treatment own healthcare, as well as their geographical location (i.e. availability and accessibility of cancer treatment services.
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Brickley, M. "Oral surgery:the referral system and telemedicine." British Dental Journal 188, no. 7 (April 2000): 384. http://dx.doi.org/10.1038/sj.bdj.4800488.
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Dailey, Ann Armstrong. "Providing a referral system for families." American Journal of Hospice Care 5, no. 3 (May 1988): 14–16. http://dx.doi.org/10.1177/104990918800500305.
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Huba, G. J., T. Luke Tharasri, Lisa A. Melchior, Arlene Schneir, Jacqueline C. Gelfand, C. Tai Kuo, Grace Shih, and Michele D. Kipke. "Computer Assisted Adolescent Referral System (CAARS)." Health Care on the Internet 3, no. 1 (January 1999): 45–54. http://dx.doi.org/10.1300/j138v03n01_05.
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