> Has anyone there done a better study, or has a reference
> value of what an
> average referral rate is expected?
>
> Best wishes,
>
> Tudor
>
An average referral rate is easy: percentage of A and E patients referred.
We run at around 25%. Some of your difference could be due to chance (you
can find a lot of applets on the net that will let you do a Fisher's exact
test or Chi squared if your computer won't do it for you), but there could
be a systematic difference between your doctors (easiest way would probably
be to repeat it). Some of this could be due to selection of patients by the
doctors. When it gets interesting is reasons why there's a difference when
the doctors see the same patients, and you don't know who's got the
appropriate referral rate (managers and inpatient teams tend to think of low
referral rates as being good. This is not always the case). It would be nice
to think you could get your computer to work this out from reattendance
rates as a proxy for inappropriate discharge but this is way too insensitive
a tool- patients who run into problems often don't come back to the same
department. You'd probably have to do it on an individual notes review (take
the 40% doc, and look at a stack of their notes, to work out whether there's
evidence that admission/ referral is appropriate). If you've got good
clerical support, then you can get your clerks to use the European
Appropriateness tool for whether admissions are appropriate (but this is a
pretty labour intensive tool, and is oversensitive in picking up
inappropriate admissions). An alternative would be to get your inpatient
teams to inform you of any patient they thought inappropriate (surprisingly
effective way of stopping grumbles about the number of inappropriate
referrals- let me know of any patient the consultant thinks inappropriate
and we'll work out a policy to avoid this kind of thing in future).
Matt Dunn
Warwick
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