PMID- 27492777
OWN - NLM
STAT- MEDLINE
DCOM- 20170711
LR  - 20181202
IS  - 1573-2584 (Electronic)
IS  - 0301-1623 (Linking)
VI  - 48
IP  - 11
DP  - 2016 Nov
TI  - Beneath the tip of the iceberg: using electronic referrals to map the 
      unquantified burden of clinical activity in a urology service.
PG  - 1751-1755
AB  - INTRODUCTION: The aim of this study was to inform health policy by demonstrating 
      the benefits of an electronic referral (e-referral) system to study inpatient 
      referrals to urology departments. METHODS: London North West Healthcare NHS Trust 
      has over 800 beds and several secondary and tertiary care services. In January 
      2014, we designed an e-referral form to requisition urology input for in-patients 
      using the Integrated Clinical Environment() (ICE) platform. We retrospectively 
      reviewed e-referral records from February to December 2014 for patient 
      demography, the referring service and disease groups triggering a referral. 
      RESULTS: There were 1192 referrals. There was a median of 107 e-referrals per 
      month (IQR 97-123, range 91-132) and 4 per day (IQR 2-6, range 0-12). Weekend 
      e-referrals were 127 (median 1, IQR 0-2, range 0-5) with 1065 e-referrals on 
      weekdays (median 4, IQR 3-6, range 0-12). A total of 848 (71.1 %) patients were 
      male, and 344 (28.9 %) were female. Patients' mean age was 63 (SD 21) years. 
      Almost half (550, 46 %) were acute referrals. Amongst the acute referrals, the 
      majority (466, 84.7 %) arose from A&E. From the non-acute conditions, 381 
      (59.3 %) patients were from the medical specialities and 246 (38.3 %) from 
      surgical disciplines. The three largest disease categories were urolithiasis 
      (287, 24.1 %), haematuria (185, 15.5 %) and for ex-catheterisation (102, 8.6 %). 
      A qualitative review showed the strengths and weaknesses of the system, enabling 
      improvements in operational efficiency. CONCLUSION: An e-referral system monitors 
      activity accurately. Systemic improvement in referral pathways would lead to 
      better patient care and enable services to factor in the unseen component of 
      workload and prompt realistic staffing.
FAU - Batura, Deepak
AU  - Batura D
AUID- ORCID: 0000-0002-2833-1819
AD  - Department of Urology, London North West Healthcare NHS Trust, Watford Road, 
      Harrow, London, HA1 3UJ, UK. deepakbatura@gmail.com.
FAU - Hashemzehi, Tumaj
AU  - Hashemzehi T
AD  - Department of Urology, London North West Healthcare NHS Trust, Watford Road, 
      Harrow, London, HA1 3UJ, UK.
FAU - Lee, Tiffany
AU  - Lee T
AD  - Department of Urology, London North West Healthcare NHS Trust, Watford Road, 
      Harrow, London, HA1 3UJ, UK.
FAU - Mahbubani, Krsna
AU  - Mahbubani K
AD  - Department of Urology, London North West Healthcare NHS Trust, Watford Road, 
      Harrow, London, HA1 3UJ, UK.
FAU - Ally, Munira
AU  - Ally M
AD  - Department of Urology, London North West Healthcare NHS Trust, Watford Road, 
      Harrow, London, HA1 3UJ, UK.
FAU - Figaszewska, Malwina Julia
AU  - Figaszewska MJ
AD  - Department of Urology, London North West Healthcare NHS Trust, Watford Road, 
      Harrow, London, HA1 3UJ, UK.
FAU - Kavia, Rajesh
AU  - Kavia R
AD  - Department of Urology, London North West Healthcare NHS Trust, Watford Road, 
      Harrow, London, HA1 3UJ, UK.
LA  - eng
PT  - Journal Article
DEP - 20160804
PL  - Netherlands
TA  - Int Urol Nephrol
JT  - International urology and nephrology
JID - 0262521
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Electronic Health Records
MH  - Emergency Service, Hospital/*statistics & numerical data
MH  - Female
MH  - Humans
MH  - Inpatients/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Referral and Consultation/*statistics & numerical data
MH  - Retrospective Studies
MH  - Specialties, Surgical/*statistics & numerical data
MH  - *Urologic Diseases/diagnosis/therapy
MH  - Urology Department, Hospital/*statistics & numerical data
OTO - NOTNLM
OT  - Medical informatics applications
OT  - Online systems
OT  - Quality improvement
OT  - Referral
OT  - Remote consultation
EDAT- 2016/08/06 06:00
MHDA- 2017/07/14 06:00
CRDT- 2016/08/06 06:00
PHST- 2016/07/08 00:00 [received]
PHST- 2016/07/29 00:00 [accepted]
PHST- 2016/08/06 06:00 [pubmed]
PHST- 2017/07/14 06:00 [medline]
PHST- 2016/08/06 06:00 [entrez]
AID - 10.1007/s11255-016-1390-0 [pii]
AID - 10.1007/s11255-016-1390-0 [doi]
PST - ppublish
SO  - Int Urol Nephrol. 2016 Nov;48(11):1751-1755. doi: 10.1007/s11255-016-1390-0. Epub 
      2016 Aug 4.