Use of an Online Referral Service for Acute Neurosurgical Referrals: An Institutional Experience

Abstract

Objective: We sought to review the current scope of emergency neurosurgical referrals and examine the long-term use of a web-based referral system.

Methods: This was a single-center retrospective observational study. Referral information was collected retrospectively over a 1-year period after the implementation of a web-based referral system (June 2019-June 2020). Information such as demographics, clinical information, referrer details, and neurosurgical response times and outcomes were collected. Statistical analyses were performed using R Version 6.3.1.

Results: Our unit received 5949 referrals with a median age of 63 years old (range: 0-107 years) (male = 50.3%). We observed an average of 16.3 referrals per day (range: 4-32), with Fridays having the highest average and the weekend days receiving statistically fewer referrals (P < 0.001). More than a third (35.9%) of referrals occurred within hours (8:00-17:00 Monday-Friday), with A + E making up approximately 50% of referrals. Common reasons for referral were traumatic brain injury, intracranial tumors, and degenerative spine. The median time from referral to first response was 32 minutes, occurring within an hour in 72.9% of cases. The median time to definite response was 83 minutes, occurring within 2 hours in 58.2% of cases. Factors found to impact the response time were referral emergency and time of day. Our acceptance rate over this period was 18.5%.

Conclusions: With an increasing number of referrals, it is feasible to provide traceable advice in a timely manner through an electronic web-based referral system transferable to any specialty. Insights could be used to direct resources and workforce planning according to emergency referral patterns.

Keywords: Emergency referral; Referral pattern; Service evaluation; Web-based referral system.