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
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Fernández-Méndez, R., Wong, M. Y., Rastall, R. J., Rebollo-Díaz, S., Oberg, I., Price, S., & Joannides, A. (2020). 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 (3), e15002. https://doi.org/10.2196/15002
BACKGROUND: Quality referrals to specialist care are key for prompt, optimal decisions about the management of patients with brain tumours. Objective: We aimed to determine the impact of introducing an web-based, electronic referral (eReferral) system to a specialised neuro-oncology centre, 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 3 key phases within the referral pathway and completion rates of 6 referral fields. RESULTS: 248 patients were referred to the specialist centre 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<0.001). Median (IQR) referral-to-MDT-decision intervals were 3 (2,7), 2 (1,3), 8 (2,24) and 3 (2,6) days respectively (P=0.011). For patients having surgery, median (IQR) diagnostic-imaging-to-surgery were 28 (21,41), 34 (27,51), 104 (69,143) and 32 (15,89) days, respectively (P<0.001). Proportions of complete fields differed significantly by referral type in all study fields (all with P<0.001) 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 69-87%, 15%-65% and 22-63% 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.
Innovate UK NIHR Brain Injury MedTech Cooperative
Technology Strategy Board (102111)
Embargo Lift Date
External DOI: https://doi.org/10.2196/15002
This record's URL: https://www.repository.cam.ac.uk/handle/1810/300167
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