NORSE

Abstract

Introduction: The health care sector has been rapidly incorporating the developments in the information technology infrastructure and also driven the development of many cutting-edge technologies such as telemedicine, electronic patient records, and digital radiology. Currently, emergency and urgent referrals by health professionals to specialist centers are conducted by telephone. This requires the referrer to wait for the operator to locate a specialist doctor who may be busy with another call or attending to a patient. If any investigations are to be done before a management plan is finalised the referrer has to re-enter this cycle again. This approach is inefficient and poses clinical governance concerns regarding the accurate communication and recording of clinical findings, management plans, and appropriate onward transfer plans. Materials and Methods: Our team has developed the Network of On-Call Referral Service in Hand Trauma (NORSE) referral system as a highly secure web-based system accessible only to medically qualified professionals. This allows the referrer and the specialist unit to engage in contemporaneous 2-way dialogue. When a referral is made, the on-call phone is alerted, and clinicians access NORSE via their on-call smartphone or PC. They can request further information and view attached images until there is enough information to reach a clear definitive management plan. The communication also forms a contemporaneous medical record. Results: We audited the response time since the incorporation of the NORSE referral system in January 2016. The unit received an average of 7 referrals on NORSE each day with over 90% of the referrals being responded within 30 minutes. The quickest response was found to be within 2 minutes. NORSE has avoided lengthy telephone conversations during referrals and has helped junior doctors as well as advanced nurse practitioners to deal with emergency workload with ease. The contemporaneous record of the referral also serves to promote accuracy of clinical details and drive up the standard of care. Conclusion: The quality and accuracy of clinical information on the referrals have improved significantly. Junior doctors have been unburdened by telephone conversations, thus allowing them to focus on honing their clinical experience. The junior doctor morale has also improved since the introduction of NORSE. We recommend that NORSE may be of benefit if used in other UK centers to promote efficiency, accuracy, and contemporaneous record of health care interaction.