Endoscopic referrals are no longer left languishing in a file cabinet.
Variable wait times and near misses in endoscopic care are a thing of the past thanks to a digital referral overhaul in South Australia.
In a webinar earlier this month, Professor Jane Andrews, the 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 650,000.
Each year, CALHN handles 12,000 endoscopic events, and a substantial number of paper-based referrals, Professor Andrews said. And it receives significantly more referrals to process that never require endoscopic services.
“We had a real challenge because when I came into the role and when covid hit, we had paper-based referrals, and we had two sites, 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 sit in folders in doctors’ offices, she said. Some clinicians would send referrals to multiple sites to find the quickest one, she added.
“I had discovered that we had two very different average wait times at our two sites for the same patient. I found we had multiple duplicate referrals. I found that we had people that we were having to continue to fill out SLS, or safety reports, for because someone would open a filing cabinet, and we would find people who were sitting around out of the flow and who had been left. And this happened multiple times.
“Thank goodness there were very few actual bad outcomes, but we had so many near misses that we were already doing a lot of internal review.
“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 adopted Novari Health’s eRequest referral management and waiting list technology system in October 2023, leading to shorter median wait times and more accurate data for resource allocation and business intelligence.
According to Novari Health figures, the software solution has led to a 40% drop in referrals to gastroenterology and colorectal surgery outpatient clinics, as a result of better triaging. More consistent and evidence-based triaging also led to a 25% drop in referrals requiring a procedure.
The technology company makes 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 the CALHN system led to the streamlining of referrals, and elimination of paper forms, reduction of duplicates and improved transparency.
The service integrates with exiting electronic management record systems, and sends out referrals to clinics and providers across different sites
“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.”
Some features of the Novari system are: 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 was important for the 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,” Professor Andrews said.
