Improving medical consults for surgical inpatients: a quality improvement project using an e-referral system linked to clinical pathways

BMJ Open Quality

article

Mahmoud Amer¹  Prosen Ghosh¹  Animesh Chatterjee¹ 

[1] Medicine , Southland Hospital;Medicine , Taranaki Base Hospital;School of Medicine , University of Otago Dunedin

关键词: hospital medicine;    information technology;    medical education;    postoperative care;    quality improvement;   

DOI  :  10.1136/bmjoq-2021-001606

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Surgical inpatients referred to medicine with acute medical problems represent a complex patient population, vulnerable to fragmented care and suboptimal outcomes. They can also be a source of staff dissatisfaction in busy or understaffed departments. Comanagement by surgical and medical staff may improve outcomes but requires dedicated resources and the evidence for other interventions is scarce. We aimed to assess staff experience, demographics and clinical outcomes of this patient population at our hospital and develop an intervention aiming to improve medical staff experience, without compromising clinical outcomes.Staff were surveyed before and after the intervention to measure staff experience. Demographics and clinical outcomes were collected for 60 referrals at baseline and 29 referrals postintervention (an e-referral system linked to locally developed clinical pathways). Clinical outcomes were delay time (time from referral submission to review), length of stay, 30-day mortality and 30-day readmissions.Medical staff experience improved from majority negative or neutral ratings to majority positive ratings postintervention and 100% of staff surveyed supported ongoing use of the intervention. There were no negative impacts on clinical outcomes, which acted as balancing measures.Medical staff experience improved, without compromising clinical outcomes. The e-referral system doubles as a platform for ongoing quality improvement.hospital medicineinformation technologymedical educationpostoperative carequality improvementData availability statementData are available on reasonable request. Anonymised data can be provided on request.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】

CC BY-NC|CC BY|CC BY-NC-ND