Development and evaluation of an electronic hospital referral system: a human factors approach

Abstract

Coordinating care across hospitals has been identified as a patient safety risk as referrals are often paper-based and poorly documented. Electronic referral systems have the potential to improve the situation but can fail to gain uptake. We applied a human factors/ergonomics (HFE) approach to place analysis of local workflow and user engagement central to the development of a new regional electronic referral system. The intervention was evaluated with a before-and-after study. Referral quality improved, referrals containing sufficient clinical information for continuation of care increased from 36.9% to 83.5% and completeness of referral information significantly improved. There was a 35.7% reduction in the number of calls to the on-call specialist, and the mean period between admission and surgery for expedited transfers was reduced. Applying HFE informed design with use-based evidence; the system maintains sustained uptake three years after implementation. Reliable recording of information translates to better patient safety during inter-hospital transitions.

Practitioners summary: This study developed, implemented and evaluated a clinical referral system using a human factors approach. Process analysis and usability studies were used to inform the application requirements and design. Region-wide implementation in hospitals resulted in the improved quality and completeness of clinical referral information and efficiencies in the referral process.

Keywords:

• Hospital referral
• human factors
• ergonomics
• quality improvement
• health information technology

Authors’ contributions

NdP, MW and LM designed and led the intervention, MW, CG & NdP conducted data analysis, MW wrote the manuscript with reviews from LM and PMC.

Acknowledgements

The authors thank Oxford University Hospitals NHS Foundation Trust for part-funding the project and to the Neurosurgery Department for supporting the initiative. Thanks are also extended to trust’s Information Management and Technology (IM&T) Department and Oxford Computer Consultants for their contributions.

Disclosure statement

In the future NdP, LM and MW may establish intellectual property rights for the referral system.

Additional information

Funding

The work was part-funded by Oxford Univeristy Hospitals NHS Foundation Trust.