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
BackgroundQuality referrals to specialist care are key for prompt, optimal decisions about the management of patients with brain tumors. ObjectiveThis study aimed to determine the impact of introducing a Web-based, electronic referral (eReferral) system to a specialized neuro-oncology ce...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JMIR Publications
2020-03-01
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| Series: | Journal of Medical Internet Research |
| Online Access: | https://www.jmir.org/2020/3/e15002 |
| _version_ | 1818879360041484288 |
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| author | Fernández-Méndez, Rocío Wong, Mei Yin Rastall, Rebecca J Rebollo-Díaz, Samuel Oberg, Ingela Price, Stephen J Joannides, Alexis J |
| author_facet | Fernández-Méndez, Rocío Wong, Mei Yin Rastall, Rebecca J Rebollo-Díaz, Samuel Oberg, Ingela Price, Stephen J Joannides, Alexis J |
| author_sort | Fernández-Méndez, Rocío |
| collection | DOAJ |
| description | BackgroundQuality referrals to specialist care are key for prompt, optimal decisions about the management of patients with brain tumors.
ObjectiveThis 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.
MethodsWe 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.
ResultsA 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.
ConclusionsAn 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 |
| first_indexed | 2024-12-19T14:28:50Z |
| format | Article |
| id | doaj.art-96acf4b9581e40e7a34bffaec0e591ca |
| institution | Directory Open Access Journal |
| issn | 1438-8871 |
| language | English |
| last_indexed | 2024-12-19T14:28:50Z |
| publishDate | 2020-03-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | Journal of Medical Internet Research |
| spelling | doaj.art-96acf4b9581e40e7a34bffaec0e591ca2022-12-21T20:17:31ZengJMIR PublicationsJournal of Medical Internet Research1438-88712020-03-01223e1500210.2196/15002Improvement of the Efficiency and Completeness of Neuro-Oncology Patient Referrals to a Tertiary Center Through the Implementation of an Electronic Referral System: Retrospective Cohort StudyFernández-Méndez, RocíoWong, Mei YinRastall, Rebecca JRebollo-Díaz, SamuelOberg, IngelaPrice, Stephen JJoannides, Alexis JBackgroundQuality referrals to specialist care are key for prompt, optimal decisions about the management of patients with brain tumors. ObjectiveThis 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. MethodsWe 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. ResultsA 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. ConclusionsAn 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)RR2-10.2196/10.2196/15002https://www.jmir.org/2020/3/e15002 |
| spellingShingle | Fernández-Méndez, Rocío Wong, Mei Yin Rastall, Rebecca J Rebollo-Díaz, Samuel Oberg, Ingela Price, Stephen J Joannides, Alexis J 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 |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| url | https://www.jmir.org/2020/3/e15002 |
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