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Altering physician referral practices remains a challenge: a spine assessment clinic quality improvement study
Ist Teil von
Canadian Journal of Surgery, 2022-12, Vol.65, p.S161-S161
Ort / Verlag
Ottawa: CMA Impact, Inc
Erscheinungsjahr
2022
Link zum Volltext
Quelle
EZB Free E-Journals
Beschreibungen/Notizen
Background: Inappropriate referrals contribute to delayed access to specialists and surgical wait lists. Referral guidelines and physician education have been shown to decrease such clinical inefficiencies. The goal of this study was to reduce the volume of inappropriate referrals to the Royal Alexandra Hospital Spine Assessment Clinic (SAC) via implementation of a quality improvement (QI) initiative. Nurse practitioners (NPs) triage incoming referrals via phone and decide surgical appropriateness on the basis of this screening. We hypothesized that we could improve surgical referral accuracy by 25% following guideline distribution. Methods: A 3-phase QI methodology was implemented. In phase 1, baseline data were collected from pre-intervention referrals by noting the physician s reason for referral and if certain information (i.e. inciting events, clinical diagnosis and physical examination findings) deemed relevant for an appropriate referral were included. In phase 2, a referral guideline, outlining when and how to refer, was developed and distributed via Alberta Health Services and primary care networks to family physicians in Northern Alberta on 2 occasions (Mar. 1 and May 18). In phase 3, Postintervention referrals and NP patient assessments were collected as in phase 1 and described using quantitative statistics and the Fisher exact test (p = 0.05). Results: A total of 406 NP patient assessments (162 pre-intervention and 244 post-intervention) were collected. The proportion of referred patients who were deemed appropriate surgical consultations was 22.2% pre-intervention, with this number increasing to 26.8% in the first 3 months post-intervention (p = 0.18). During the following 3-month period this value further increased to 36.3%, significantly improved relative to pre-intervention (p = 0.039). Conclusion: We found a positive trend in the proportion of patients deemed surgical candidates post-intervention. This study demonstrates the challenge associated with changing physician behaviour. Translating guidelines into practice is a recognized issue; it requires time and multiple exposures. Active forms of medical education and multifaceted interventions have been demonstrated to be the most effective means of implementing guidelines into practice, an approach that could further address SAC referral inadequacies.