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Journal of Burn Care & Research :... May 2021Burn injury represents a substantial burden of disease in resource-limited settings. Kenya has no formal trauma system and referral practices for burn injuries are not...
Burn injury represents a substantial burden of disease in resource-limited settings. Kenya has no formal trauma system and referral practices for burn injuries are not well understood. The purpose of this study was to determine the factors associated with burn injury referrals in rural Kenya. A retrospective chart review was conducted for patients with burn injury from January 1, 2014 to December 31, 2017 at a 300-bed faith-based, teaching hospital in southwest Kenya. Bivariate analysis compared referred and non-referred patients. Multivariable logistic regression was used to assess the association between burn severity and odds of referral adjusting for age, sex, insurance, time from injury to arrival, and estimated travel time from home to hospital. The study included 171 patients with burn injury; 11 patients were excluded due to missing referral data. Of the 160 patients, 31.9% (n = 51) were referred. Referral patients had higher average total body surface area burn (23.1 ± 2.4% vs 11.1 ± 1.2%, P < .001), were more likely to have full-thickness burns (41.3% vs 25.5%, P = .05), and less likely to present to the referral hospital within 24 hours after injury (47.8% vs 73.0%, P = .005). Referral patients had longer travel time to hospital (90+ min: 52.9% vs 22.0%, P < .001). Odds of referral increased 1.62 times (95% confidence interval: 1.19-2.22) for every 10% increase in total body surface area burn. Without a coordinated trauma system, referrals represent a substantial portion of burn injury patients at a hospital in rural Kenya. Referred patients present with more severe burns and experience delays to presentation.
Topics: Adult; Aged; Burns; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Kenya; Male; Middle Aged; Referral and Consultation; Retrospective Studies; Risk Factors; Rural Population
PubMed: 33095863
DOI: 10.1093/jbcr/iraa187 -
Value in Health Regional Issues Sep 2022This study aimed to assess the cost-effectiveness of a remotely operated referral management system (RORMS) compared with a conventional referral management system...
OBJECTIVES
This study aimed to assess the cost-effectiveness of a remotely operated referral management system (RORMS) compared with a conventional referral management system (CRMS) in Brazil.
METHODS
This is a model-based cost-effectiveness analysis under the perspective of the Unified Healthcare System (Sistema Único de Saúde [SUS]) in Brazil. A Markov microsimulation model was developed to compare costs and referral outcomes of the RORMS and the CRMS. Model consisted of 4 states representative of sequential stepwise assessments of referral suitability, 3 states representative of referral outcomes, and 1 exit model state. Target population represented cases being referred from primary healthcare units to specialized care in SUS. Model inputs related to costs and effectiveness in the RORMS arm were obtained from the data set of a RORMS between July and December 2019. Model inputs for the CRMS model arm were obtained from administrative data sets of 2 Brazilian localities for the year 2019. Relative effect size of RORMS in comparison with CRMS in SUS was obtained from published studies. Effectiveness outcome was unnecessary referrals averted. The incremental cost-effectiveness ratio was calculated for the base case. Probabilistic sensitivity analysis was conducted.
RESULTS
In the base-case analyses, RORMS dominated CRMS, with expected cost-savings from $50.42 to $80.62 per unnecessary referral averted. RORMS was the dominant strategy in 83.7% of 100 000 simulations in the probabilistic sensitivity analysis. In 16.2% of simulations, incremental cost-effectiveness ratio was between $0 and $222 per unnecessary referral averted.
CONCLUSIONS
Model-based simulations indicate that the RORMS is likely to be cost saving in comparison with the CRMS.
Topics: Brazil; Cost-Benefit Analysis; Humans; Referral and Consultation; Secondary Care; Telemedicine
PubMed: 35568011
DOI: 10.1016/j.vhri.2022.03.003 -
World Neurosurgery Sep 2022We sought to review the current scope of emergency neurosurgical referrals and examine the long-term use of a web-based referral system. (Observational Study)
Observational Study
OBJECTIVE
We sought to review the current scope of emergency neurosurgical referrals and examine the long-term use of a web-based referral system.
METHODS
This was a single-center retrospective observational study. Referral information was collected retrospectively over a 1-year period after the implementation of a web-based referral system (June 2019-June 2020). Information such as demographics, clinical information, referrer details, and neurosurgical response times and outcomes were collected. Statistical analyses were performed using R Version 6.3.1.
RESULTS
Our unit received 5949 referrals with a median age of 63 years old (range: 0-107 years) (male = 50.3%). We observed an average of 16.3 referrals per day (range: 4-32), with Fridays having the highest average and the weekend days receiving statistically fewer referrals (P < 0.001). More than a third (35.9%) of referrals occurred within hours (8:00-17:00 Monday-Friday), with A + E making up approximately 50% of referrals. Common reasons for referral were traumatic brain injury, intracranial tumors, and degenerative spine. The median time from referral to first response was 32 minutes, occurring within an hour in 72.9% of cases. The median time to definite response was 83 minutes, occurring within 2 hours in 58.2% of cases. Factors found to impact the response time were referral emergency and time of day. Our acceptance rate over this period was 18.5%.
CONCLUSIONS
With an increasing number of referrals, it is feasible to provide traceable advice in a timely manner through an electronic web-based referral system transferable to any specialty. Insights could be used to direct resources and workforce planning according to emergency referral patterns.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Brain Neoplasms; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Male; Middle Aged; Referral and Consultation; Retrospective Studies; Young Adult
PubMed: 35738533
DOI: 10.1016/j.wneu.2022.06.071 -
BMC Health Services Research Jul 2022Radiology professionals are frequently confronted with referrals containing insufficient clinical information, which hinders delivery of safe and quality medical imaging...
BACKGROUND
Radiology professionals are frequently confronted with referrals containing insufficient clinical information, which hinders delivery of safe and quality medical imaging services. There is however lack of knowledge on why and how referral information is important for radiographers in clinical practice. This study explores what purposes referral information is used/ useful for the radiographers, and the benefits of involving them in assessing referrals.
METHODS
A cross sectional study was conducted of radiographers recruited through the International Society of Radiographers and Radiological Technologists (ISRRT) networks. A questionnaire was developed and distributed consisting of 5-point Likert scale questions on a) use/usefulness of referral information for 12 listed purposes and b) the benefits of radiographers assessing referrals for 8 possible reasons. The questionnaire was validated using a test-retest reliability analysis. Kappa values ≥0.6 were accepted. SPSS software was used for data analysis and chi-square tests to determine associations between using referral information and background variables.
RESULTS
Total respondents were 279 (n = 233 currently in clinical practice and n = 46 in other positions). The participants in clinical practice ranked high all 12 listed purposes for use of referral information, and all except one received ≥60% 'frequent'/'very frequent' responses. Use for patient identification purposes received the highest score (97% 'frequently'/'very frequently' responses), followed by ensuring imaging of the correct body region (79% 'very frequently' responses). Radiographers not currently working in clinical practice ranked the 'usefulness' of listed items similarly. Significant associations between frequent use of referral information and education level were not observed, and only three items were significantly associated with modality of practice. All items on benefits of radiographers assessing referrals received ≥75% 'agree'/'strongly agree' scores. The items ranked highest were promotes radiographers' professional responsibility and improves collaboration with radiologists and referring clinicians, with 72 and 67% strongly agreed responses, respectively.
CONCLUSION
Radiographers use referral information frequently for several purposes. The referral information is needed for justifying and optimising radiological procedures, hence crucial for ensuring patient safety and high-quality services. This further emphasis why radiographers perceive several benefits of being involved in assessing the referral information.
Topics: Cross-Sectional Studies; Humans; Radiologists; Radiology; Referral and Consultation; Reproducibility of Results
PubMed: 35810310
DOI: 10.1186/s12913-022-08291-w -
Australian Journal of General Practice Dec 2023Referrals are a critical component of the Australian healthcare system, with referrals from general practitioners (GPs) to non-GP specialists making up the majority of...
BACKGROUND
Referrals are a critical component of the Australian healthcare system, with referrals from general practitioners (GPs) to non-GP specialists making up the majority of medical referrals. Given the key role referrals have in primary healthcare, it is important that GPs understand their legal and professional responsibilities when providing a referral and ensure they refer appropriately and effectively to provide the best health outcomes for patients.
OBJECTIVE
This article explores GP referrals to other health professionals and aims to describe a doctor's medicolegal obligations and responsibilities when making a referral.
DISCUSSION
The responsibility of GPs in the referral process reflects their central coordinating role as providers of primary care, and the reliance patients place upon them to advise and recommend treatment and investigations. Understanding the medicolegal obligations and responsibilities when writing a referral can help GPs find the right balance between respecting patient autonomy and the professional obligation to take reasonable steps to ensure referrals and investigations are acted upon appropriately. The key to an effective referral process is clear communication between practitioners and patients, to help align the expectations of all involved so they can agree and implement a shared treatment plan in the interests of the patient.
Topics: Humans; General Practitioners; Australia; Referral and Consultation; Specialization; Patients
PubMed: 38049129
DOI: 10.31128/AJGP-08-23-6921 -
Ophthalmic & Physiological Optics : the... Mar 2021In the UK, most referrals to the hospital eye service (HES) originate from community optometrists (CO). This audit investigates the quality of referrals, replies, and...
PURPOSE
In the UK, most referrals to the hospital eye service (HES) originate from community optometrists (CO). This audit investigates the quality of referrals, replies, and communication between CO and the HES.
METHODS
Optometric referrals and replies were extracted from three practices in England. If no reply letter was found, the records were searched at each local HES unit, and additional replies or records copied. De-identified referrals, replies and records were audited by a panel against established standards to evaluate whether the referrals were necessary, accurate and directed to the appropriate professional. The referral rate (RR) and referral reply rate (RRR) were calculated.
RESULTS
A total of 459 de-identified referrals were extracted. The RR ranged from 3.6%-8.7%. The proportion of referred patients who were seen in the HES unit was 63%-76%. From the CO perspective, the proportion of referrals for which they received replies ranged from 26%-49%. Adjusting the number of referrals for cases when it would be reasonable to expect an HES reply, RRR becomes 38%-62%. Patients received a copy of the reply in 3%-21% of cases. Referrals were made to the appropriate service in over 95% of cases, were judged necessary in 93%-97% and were accurate in 81%-98% of cases. The referral reply addressed the reason for the referral in 93%-97% and was meaningful in 94%-99% of cases. The most common conditions referred were glaucoma, cataract, anterior segment lesions, and neurological/ocular motor anomalies. The CO/HES dyad (pairing) in the area with the lowest average household income had the highest RR.
CONCLUSIONS
In contrast with the Royal College of Ophthalmologists/College of Optometrists joint statement on sharing patient information, CO referrals often do not elicit a reply to the referring CO. Replies from the HES to COs are important for patient care, benefitting patients and clinicians, and minimising unnecessary HES appointments.
Topics: Communication; Community Health Services; Cross-Sectional Studies; England; Glaucoma; Hospital Shared Services; Optometrists; Referral and Consultation
PubMed: 33354812
DOI: 10.1111/opo.12772 -
AJR. American Journal of Roentgenology Jul 2022We describe our experience in synchronous virtual radiologist consultations, whereby a radiologist at the PACS uses a conferencing platform to join a primary care visit...
We describe our experience in synchronous virtual radiologist consultations, whereby a radiologist at the PACS uses a conferencing platform to join a primary care visit between a patient at home and a referring provider, at home or at clinic, to directly explain imaging results and partner with the referrer in forming management recommendations. We explore the model's significance in the context of patient-centered care. Implementation, obstacles, and potential impact on health care disparities are also discussed.
Topics: Humans; Patient-Centered Care; Radiography; Radiologists; Radiology; Referral and Consultation
PubMed: 35080459
DOI: 10.2214/AJR.21.27270 -
Telemedicine Journal and E-health : the... Jan 2021Electronic consultations (eConsults) and referrals (eReferrals) are being implemented to improve access to specialist care. As eConsult and eReferral services rely on a...
Electronic consultations (eConsults) and referrals (eReferrals) are being implemented to improve access to specialist care. As eConsult and eReferral services rely on a roster of engaged specialists for their success, careful attention must be paid to how the term "specialist" is defined, what criteria inform specialists recruitment, and how quality of specialist responses can be monitored and maintained. Key considerations, informed by our personal experiences, review of best practice documents, international frameworks of specialists roles and competencies and a focused small group discussion among providers, health service planners and researchers for each of these important elements is discussed. Individuals participating in services should receive clear expectations around their role and responsibilities and be provided equitable access assuming they meet the necessary requirements. Training and feedback should be provided to ensure timely, quality responses. Paying attention to these key elements will reduce confusion, frustration and disengagement amongst specialists and ensure high quality responses.
Topics: Health Services Accessibility; Humans; Primary Health Care; Referral and Consultation; Specialization
PubMed: 32302516
DOI: 10.1089/tmj.2020.0023 -
The British Journal of Oral &... Jun 2023The OMFS urgent suspicion of cancer (USOC) referral pathway for head and neck cancer is costly in terms of time and resources, and despite NICE referral guidance, it has...
The OMFS urgent suspicion of cancer (USOC) referral pathway for head and neck cancer is costly in terms of time and resources, and despite NICE referral guidance, it has a low conversion rate with many inappropriate referrals. The Head and Neck Cancer Risk Calculator version 2 (HaNC-RC-v2) gives recommendations to primary care referrers on appropriate referral priority. To our knowledge, this is the first study to investigate the accuracy of the HaNC-RC-v2 in a cohort of maxillofacial referrals. Electronic patient records were reviewed for all malignancies diagnosed by OMFS in 2019 (n = 54), and a sample of USOC referrals to OMFS (n = 204). The HaNC-RC-v2 was applied to each patient, using information from the referral letter and the clinical notes from the new patient consultation. The mean and median HaNC-RC-v2 scores for patients with malignancy were 42.22% and 32.23%, respectively. For patients without malignancy, mean and median scores were 9.27% and 5.68%, respectively. There was a statistically significant relation between the presence/absence of malignancy and the recommendation made by the risk calculator (p = 0.0012). The calculator recommended USOC referral for 76% (41/54) of patients with malignancy, and only 41% (83/204) of patients without malignancy. The negative predictive value of the HaNC-RC-v2 was 99.2%. The calculator has the potential to reduce the number of inappropriate referrals to OMFS via the USOC pathway.
Topics: Humans; Head and Neck Neoplasms; Referral and Consultation; Predictive Value of Tests
PubMed: 37169617
DOI: 10.1016/j.bjoms.2023.04.001 -
Applied Ergonomics Nov 2020Consultations entail transitions in care between referrers and consultants, as patients visit different clinicians and care sites. This complex process has been...
Consultations entail transitions in care between referrers and consultants, as patients visit different clinicians and care sites. This complex process has been consistently prone to communication breakdowns. Despite expectations and benefits of electronic health records (EHRs), incomplete, vague, or inappropriate referrals continue to hinder consultations; referrals can be sent to the wrong specialty service; and consultation findings frequently fail to reach referrers. Due to the inadequate support of interpersonal communication afforded by EHRs, these issues persist. Important aspects of ergonomics and human factors engineering frequently appear overlooked during the design and implementation of EHRs. Usability issues have contributed to delays in medical diagnosis, treatment, and follow-up. Some of these delays contribute to patient harms. Our multidisciplinary team of clinicians and ergonomics professionals reflects on referral and consultation. We describe how computerization in healthcare should benefit from approaches informed and developed through applied ergonomics and human factors.
Topics: Electronic Health Records; Ergonomics; Humans; Referral and Consultation; Systems Analysis; Transitional Care
PubMed: 32768721
DOI: 10.1016/j.apergo.2020.103227