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Electronic optional guidelines as a tool to improve the process of referring patients to specialized care: an intervention study.

Rokstad IS, Rokstad KS, Holmen S, Lehmann S, Assmus J - Scand J Prim Health Care (2013)

Bottom Line: The GPs did not know that their referrals were being evaluated.The specialists reported significantly higher referral quality and considerably less time spent on evaluating referrals when using the EOGT, with an overall time reduction of 34%.In fact, the tool may be even more beneficial for the GP.

View Article: PubMed Central - PubMed

Affiliation: Haukeland University Hospital, Norway.

ABSTRACT

Objective: The main objective of this paper is to investigate whether incorporating an electronic optional guideline tool (EOGT) in the standardized referral template used by general practitioners (GPs) when referring patients to specialized care can improve outpatient referral appropriateness.

Design: Intervention study with an intervention and a control group.

Setting: 210 GPs in the municipality of Bergen and the Department of Thoracic Medicine at Haukeland University Hospital.

Subjects: 2400 patients referred to the Department of Thoracic Medicine at Haukeland University Hospital.

Results: An electronic optional guideline tool (EOGT) was implemented on 93 of 210 GPs' computer systems. The referral quality and the time spent reviewing each referral were evaluated by the hospital specialists. The GPs did not know that their referrals were being evaluated. The specialists were blinded with regard to information concerning the intervention and the control group. The specialists reported significantly higher referral quality and considerably less time spent on evaluating referrals when using the EOGT, with an overall time reduction of 34%. Likewise, GPs also reported that the EOGT was easy to use, time-saving and led to an improved quality of their referrals.

Conclusion: This study documents an improvement in the quality of the referrals. Since the GPs save time by using the EOGT, there is no reason to believe that they will discontinue using it. In fact, the tool may be even more beneficial for the GP. The authors believe that it is possible to implement the EOGT as a standard referral tool within various fields of medicine and are currently in the process of developing these tools.

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Related in: MedlinePlus

The information box above appeared in the upper right corner of the electronic standardized referral template when the GP selected COPD, SA, or LT as the reason for referral.
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Figure 1: The information box above appeared in the upper right corner of the electronic standardized referral template when the GP selected COPD, SA, or LT as the reason for referral.

Mentions: The outpatient clinic at the Department of Thoracic Medicine, Haukeland University Hospital, annually receives about 2400 patient referrals. Of these, 60% are diagnosed with SA, COPD, or LT. For each of the diagnoses seven or eight indicators were listed. When the GPs wrote a referral to a specialist using this tool, the GPs first decided on a tentative diagnosis using clinical skills and knowledge. If this tentative diagnosis was an LT, SA, or COPD, the EOGT provided an information box (Figure 1) corresponding to the diagnosis at hand. This provided a reminder regarding which information the GP should provide in order to increase the appropriateness of the referral. In Norway it is common practice for most GPs to write the referral while the patient is present in the consultation room. This means that the GP can use the EOGT guidelines to gather information about the patient directly and simultaneously write the referral.


Electronic optional guidelines as a tool to improve the process of referring patients to specialized care: an intervention study.

Rokstad IS, Rokstad KS, Holmen S, Lehmann S, Assmus J - Scand J Prim Health Care (2013)

The information box above appeared in the upper right corner of the electronic standardized referral template when the GP selected COPD, SA, or LT as the reason for referral.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750439&req=5

Figure 1: The information box above appeared in the upper right corner of the electronic standardized referral template when the GP selected COPD, SA, or LT as the reason for referral.
Mentions: The outpatient clinic at the Department of Thoracic Medicine, Haukeland University Hospital, annually receives about 2400 patient referrals. Of these, 60% are diagnosed with SA, COPD, or LT. For each of the diagnoses seven or eight indicators were listed. When the GPs wrote a referral to a specialist using this tool, the GPs first decided on a tentative diagnosis using clinical skills and knowledge. If this tentative diagnosis was an LT, SA, or COPD, the EOGT provided an information box (Figure 1) corresponding to the diagnosis at hand. This provided a reminder regarding which information the GP should provide in order to increase the appropriateness of the referral. In Norway it is common practice for most GPs to write the referral while the patient is present in the consultation room. This means that the GP can use the EOGT guidelines to gather information about the patient directly and simultaneously write the referral.

Bottom Line: The GPs did not know that their referrals were being evaluated.The specialists reported significantly higher referral quality and considerably less time spent on evaluating referrals when using the EOGT, with an overall time reduction of 34%.In fact, the tool may be even more beneficial for the GP.

View Article: PubMed Central - PubMed

Affiliation: Haukeland University Hospital, Norway.

ABSTRACT

Objective: The main objective of this paper is to investigate whether incorporating an electronic optional guideline tool (EOGT) in the standardized referral template used by general practitioners (GPs) when referring patients to specialized care can improve outpatient referral appropriateness.

Design: Intervention study with an intervention and a control group.

Setting: 210 GPs in the municipality of Bergen and the Department of Thoracic Medicine at Haukeland University Hospital.

Subjects: 2400 patients referred to the Department of Thoracic Medicine at Haukeland University Hospital.

Results: An electronic optional guideline tool (EOGT) was implemented on 93 of 210 GPs' computer systems. The referral quality and the time spent reviewing each referral were evaluated by the hospital specialists. The GPs did not know that their referrals were being evaluated. The specialists were blinded with regard to information concerning the intervention and the control group. The specialists reported significantly higher referral quality and considerably less time spent on evaluating referrals when using the EOGT, with an overall time reduction of 34%. Likewise, GPs also reported that the EOGT was easy to use, time-saving and led to an improved quality of their referrals.

Conclusion: This study documents an improvement in the quality of the referrals. Since the GPs save time by using the EOGT, there is no reason to believe that they will discontinue using it. In fact, the tool may be even more beneficial for the GP. The authors believe that it is possible to implement the EOGT as a standard referral tool within various fields of medicine and are currently in the process of developing these tools.

Show MeSH
Related in: MedlinePlus