Junior doctor-led quality improvement project to improve safety and visibility of an interspecialty referral system

BMJ Open Quality

article

Dowan Kwon¹  Won Young Moon²  Michelle Akhunbay-Fudge³  Brandon Pieters⁴  Jeni Pillai⁵  Charlie Wilson⁶  Jo Morrison⁷ 

[1] South Bristol Academy/Undergraduate Education Department, Trust Services , Bristol Royal Infirmary;Department of Ophthalmology , Royal Berkshire NHS Foundation Trust;Department of Acute Internal Medicine , Wexham Park Hospital;Musgrove Park Academy , Somerset NHS Foundation Trust;Department of Psychiatry , Homerton University Hospital, East London Foundation Trust;Department of Anaesthetics , Somerset NHS Foundation Trust;Department of Gynaecological Oncology , Somerset NHS Foundation Trust

关键词: communication;    quality improvement;    patient safety;    electronic health records;    efficiency;    organisational;   

DOI  :  10.1136/bmjoq-2020-001323

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Interspecialty referrals for increasingly complex hospital inpatients are common and miscommunication often leads to delays in patient care. In a district general hospital, a web-based system generated an email referral, which lacked visibility and tracking/audit of the process, with no record generated automatically in paper inpatient notes or electronic patient records (EPR). We aimed to improve the visibility and safety of the interspecialty referral system.We canvassed stakeholders, informally and via an online satisfaction survey, collecting qualitative and quantitative data about attitudes to the existing system, generating ideas for change. We process mapped the system, identifying points of weakness. We adapted our EPR system, using a work-around solution, to develop a form that could be emailed from the EPR. This generated a permanent record within the EPR and an electronic record of the referral having been sent. We measured the visibility of referrals and responses within the EPR. We generated an online training ‘how-to’ video and reaudited stakeholder satisfaction.There was a significant increase in the proportion of junior doctors satisfied or very satisfied with the interspecialty referral system (27/31 postintervention; 87.1% vs 26/55 preintervention; 47%; p<0.0001) and more believed that the visibility was adequate or very adequate (24/31 postintervention; 77.4% vs 9/55 preintervention; 16.4%; p<0.0001). Visibility of referrals by project team members on the EPR increased from a baseline of 3.5% to 83.6% and the visibility of responses to these referrals on the EPR increased from 4.6% to 40.7%. Qualitative feedback was excellent, hospital executive approval was gained and our work-around system spread to non-team members.We developed a more visible and reliable interspecialty referral system, adapting existing EPR capabilities, which was popular with users and led to cultural change in interspecialty referral responders. A formal EPR redesign, informed by our project, is in development.communicationquality improvementpatient safetyelectronic health recordsefficiencyorganisationalData availability statementAll data relevant to the study are included in the article or uploaded as supplementary.http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

【 授权许可】

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