Doctors Improving Referrals project: a referrals toolkit for junior doctors

Abstract

Every day in hospitals around the world, millions of interspecialty referrals are made to obtain advice on the optimal care and management of patients. In the UK, the brunt of this work is undertaken by junior doctors with less clinical experience than the specialist colleagues to which they refer. A survey of 283 junior doctors revealed that colleagues were underconfident when making referrals and struggled to know which specialty to contact, how to reach the specialty and what clinical information to include in the referral. More concerningly, 10% of those surveyed had experienced bullying or belittling behaviours and verbal aggression from colleagues when referring.The aim of this project was to design and implement a referrals toolkit for junior doctors to improve confidence making referrals and time to interspecialty advice, to improve patient care. Process mapping to understand the constituents of good referrals was combined with a failure modes and effects analysis describing how referrals fail to identify areas for intervention.A specialty referrals guide with all specialty contact information was created at the trust, demonstrating an increase in junior doctor median confidence from 3/5 (n=20) to 5/5 (n=23) (p<0.001); 65% found it quicker to refer with the guide and 81% found an improved time to discharge. A referrals cheat sheet was also created, containing specialty-specific information to be included when making a referral. This has been downloaded over 23 000 times from around the globe. Of survey respondents (n=43), 74% noted improved confidence in making referrals, 26% noted faster time to specialty advice and 19% found a positive impact on patient discharges. Overall, the referrals toolkit has been beneficial for both junior doctors and the patients for which they care and has been accessed by over 50% of new foundation doctors in 2021 and 2022.

Keywords: Continuous quality improvement; Healthcare quality improvement; Quality improvement; Quality improvement methodologies.

Figure 1

An excerpt from the questionnaire disseminated to junior doctors, including an example of one of the Likert scales used. *response required

Figure 2

Word diagram of quotes from specialists that junior doctors experienced after making referrals.

Figure 3

An excerpt from a page of the Ealing specialty referrals guide. ENT, ear, nose and throat; EPRO, online clinical software platform utilised in the hospital trust; ERCP, Endoscopic Retrograde Cholangiopancreatography; GI, gastrointestinal; ICE, Integrated Clinical Environment; MDT, multidisciplinary team; NHS, National Health Service; UGI, upper gastrointestinal.