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

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.

Key Words::

• General practice
• general practitioners
• intervention studies
• lung diseases
• Norway
• outpatients
• quality improvement
• referral and consultation

Contributors

KSR, SH, and SL contributed to the conception and design of the study. KSR, SH, SL, and JA contributed to the analysis and all authors contributed to the interpretation. ISR drafted the article; all authors revised it critically and approved the final version submitted for publication. KSR is the guarantor.

Funding

None. Infodoc Plenario agreed to implement our EOGT free of charge.

Declaration of interests

The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.

No support from any company for the work submitted; no financial relationships with any companies that might have an interest in the work submitted during the previous three years; and no non-financial interest that may be relevant to the work submitted.

Data sharing

No additional data available.