Endoscopic referrals provide greater safety - ensuring none are lost and all are managed in turn.
Variable wait times, lost referrals and time hunting for paper forms in endoscopic care are a thing of the past thanks to a digital referral overhaul in South Australia.
In a recent webinar, Professor Jane Andrews, the former divisional director for GI services in central Adelaide, spoke about how referral and waitlist management technology helped transform the Central Adelaide Local Health Network (CALHN).
The service comprises two acute care hospitals in Adelaide, the Royal Adelaide Hospital and the Queen Elizabeth Hospital, with seven units involved in endoscopic services, serving a population of approximately 650,000.
Each year, CALHN delivers about 12,000 endoscopic events, yet receives thousands more referrals than this, with a substantial proportion of the referrals being paper-based, Professor Andrews said.
CALHN, like all large healthcare organisations, receives significantly more referrals to process than the number of people in whom endoscopic services are indicated and subsequently delivered.
“We had a real challenge because when I came into the role and covid hit soon after, we had paper-based referrals, across two sites, with seven different clinical services who could receive a referral, and many different ways in: by fax, by phone call, by snail mail, email, all sorts of different referral inflows,” Professor Andrews said.
Referrals would arrive via the outpatient service, nurse-facilitated triage service or sometimes sit in folders in doctors’ offices, she said. It was also apparent that some external clinicians would send referrals to multiple sites to find the quickest one, she added, as metrics around waiting times were not transparent.
“I had discovered that we had two very different average wait times at our two sites for people with the same indication,” Professor Andrews said.
“I found we had multiple duplicate referrals. I found that we had more than one instance where staff had to fill out SLS, or safety reports, because someone would open a filing cabinet, and we would find referrals which were sitting around out of the workflow and had been left. Unfortunately, this happened multiple times.
“Thank goodness there were very few actual bad outcomes, but we had so many near misses that prior to the digital pathway, we were already doing a lot of internal review of endoscopic referral management.
“We had a real need to tidy up that mess so that things were fair, so that they were transparent and so that we had safety in not losing paper-based referrals.”
CALHN implemented a trial of Novari Health’s eRequest referral management and waiting list technology system in October 2023, leading to clarity and consistency of median wait times across sites and amongst units, and more accurate data for resource allocation and business intelligence.
According to CALHN data, in the six months after implementation of new pathway supported by Novari’s software solution, there was a 40% drop in on rates in the gastroenterology and colorectal surgery outpatient clinics, due to senior nurse triage of routine endoscopic referrals.
More consistent and evidence-based triaging also led to 25% of referrals being able to exit the pathway without needing to have an endoscopic service.
The technology company made bespoke workflows according to the needs of the system, CEO John Sinclair told the audience. This included integrating with HealthLink and other e-referral systems already widely deployed to receive those referrals, and physician practice management solutions.
Its adoption in CALHN led to the streamlining of referrals, and elimination of paper forms, reduction of duplicates and improved transparency.
The service can integrate with exiting electronic management record systems and distribute referrals to clinics and providers across different sites as determined by the needs of each customer.
“On the back end, we provide very rich analytical capabilities,” Mr Sinclair said.
“First of all, we give the client like CALHN a copy of the database, so they can go in and they can look at their data. They can understand where the referrals are coming from, what type of referrals they’re receiving, how they’re being triaged, what’s the urgency, what’s the disease category or specialty or subspecialty, how long it’s taking for them to get triaged and how long it’s taking them to get scheduled.”
Features of the Novari system include real-time visibility of the status of every referral, so clinicians can see exactly where it is in the queue and make sure no referrals slip through the cracks, and the ability for users to see referral volumes, triage times and schedules.
This kind of high-quality data is important for any organisation to be able to adhere to the National Colonoscopy Clinical Care Standards and meet hospital accreditation requirements, Professor Andrews said.
“That’s really powerful because now we actually have much better business intelligence to know who’s coming in, what percentage of referrals are judged to be appropriate and indicated for a procedure, and then we can also look at their total wait time by indication because that’s hugely important,” she said.
“We haven’t solved our wait list, but now we’ve got a chance to solve the wait list, because we can really see what we’re meant to be delivering, why and for whom, and we can share the metrics, so that if we need to have a business case developed, we’ve got really great business intelligence that is true to share with our managers, the health department and the politicians who have to judge [questions like whether they are] going to divert funds towards endoscopic services or…treat cancer downstream.”
