The RMH Diabetes Education Service (DES) receives inpatient referrals via an electronic referral system Patient Flow Manager (PFM). Inefficiencies in referral processes use Diabetes Educator resources ineffectively, impede triage and the delivery of quality, timely care becomes a challenge. A well-planned discharge can avoid last minute scrambles and delays before patients go home. Poor early discharge planning affects patient’s preparedness for home and potentially delayed discharge. Additionally, hospital capacity is reduced by slowed access and flow, and comes at a financial cost.
To address inefficiencies of inpatient referrals for Diabetes Education by making changes to the PFM referral reason tabs.
Inpatient referrals to the DES were monitored over two 5 week periods; pre-implementation of changes and post. Audit results were compared to assess whether there was an improvement in the referrals received. The referring wards were given feedback after both audits.
Pre-implementation of the new referral tabs there were 202 active inpatient referrals made to the DES; 68 (34%) were deemed ‘inappropriate’ and some had caused a delay in patient discharge. On average 7 active referrals per day, with 2-3 ‘inappropriate’ referrals per day. Post-implementation of the new referral tabs there were 175 active inpatient referrals made to the DES; 33 (18%) were deemed ‘inappropriate’. On average 6 active referrals per day, with 1 ‘inappropriate’ referral per day.
The changes to the referral reason tabs reduced inappropriate referrals made to the DES by 16%. Anecdotally, the team felt there was less time-wastage following up on inappropriate/ unclear referrals and that this led to improved efficiency, timeliness and therefore quality in the service provided to patients and their families. It is anticipated that the changes will contribute to reduced instances of discharge delays and better discharge outcomes as well as improved inpatient access and flow at RMH.