Internal Referrals Research Articles

Dealing with the turnover tsunami: Strategies for attracting and retaining the best talent

We begin by looking at the causes of the postpandemic staffing crisis and evaluate its impact on the orthodontic industry. Strategies to minimize the negative impact of this talent shortage are discussed. A smart recruitment plan that has specific, measurable goals should be implemented. Various aspects of a successful recruitment plan like creating compelling job descriptions, posting on nontraditional platforms, using internal employee referrals to hire, monitoring your online employer reputation, treating potential employees like customers, the inclusion of the team in the hiring process, designing a consistent and professional onboarding process, and, using key performance indicators to monitor the efficacy of the recruitment strategy are highlighted. The article also discusses the importance of creating a positive workplace culture. Several ways to foster a desirable work culture are discussed, including clarifying the company mission and vision, compensating fairly and incentivizing, instituting open communication channels, and encouraging employee personal development. Shifting the focus from managing to leading is crucial to engaging the team and achieving long-term practice growth goals.

Today\u2019s referral is tomorrow\u2019s repeat patient: referrals to and between medical outpatient clinics in a hospital

BackgroundUnnecessary referrals in Danish hospitals may be contributing to inefficient use of health services already stretched and under pressure and may lead to delayed treatment for patients. Despite a growing awareness in the literature and in practice of issues related to referrals, there has been relatively little research on referrals between specialists in hospital outpatient clinics and how it can be improved. This study aimed to describe the referral patterns to and within the Medical Department at the University Hospital of Southern Denmark. The Medical Department consists of the following medical specialist outpatient clinics; nephrology, pulmonology, endocrinology, cardiovascular, wound outpatient clinic, and a day hospital.MethodsTwo specialist physicians assessed all referrals to the medical specialist outpatient clinics over one month (from 01 September 2019 to 30 September 2019) using data drawn from the Danish electronic patient record system (Cosmic). Data on referral pattern, and patient age and sex, were statistically analysed to identify and characterise patterns of referral.ResultsFour hundred seventy-one (100%) referrals were included in the study. 49.5% (233) of the referrals were from the hospital and 50.5% (238) from general practitioners (GPs). Of the 233 referrals from the hospitals, 31% (72) were from the Medical Department.ConclusionThe high rate of referrals (31%) from own Medical Department or outpatient clinics may reflect an inefficient internal referral process within the department. Improved collaboration between specialists could have the potential to improve health outcomes, timely access to care and more appropriate healthcare resource utilisation.

Bir Türk Diş Hekimliği Fakültesinde Çocuk Hastalarda Konik Işınlı Bilgisayarlı Tomografi Kullanımı

Objectives: The purpose of the present study was to provide information that might help in planning cone-beam computed tomography (CBCT) imaging in pediatric patients. This study focused on the evaluation of indications for CBCT in pediatric patients in a Turkish dental school. 
 Method: Six-hundred-seven CBCT scans belonged to patients under the age of 16 were included in this study. The following data were recorded from an electronic patient database: age, gender, indication for referral (impacted teeth, supernumerary teeth, trauma, cysts/tumors, clefts, temporomandibular joint, and other reasons), dispersion of referrals by departments, external or internal referral.
 Results: Mean age was 12.39 years [range: 4-16; 260 females (42.8%) and 347 males (57.2%)]. The most frequent and largest age group (54.2%) was 13- to 16-years old. The most frequent request was to assess an impacted tooth and its localization (38.2%). Examining the FOVs, the maxilla was the most frequently imaged area (27.2%). Four-hundred sixty-six patients (76.8%) had been referred from departments of the dental school while 141 (23.2%) patients were referred from external clinics. Re-exposure was required in 52 cases (8.6%) due to patient-motion artefacts. 
 Conclusion: The results of the present study can help dental professionals make the decision to refer for CBCT when extra three dimensional imaging is necessary for a pediatric patient. It might be proper that an oral and maxillofacial radiologist decides when CBCT is necessary and then supervises the CBCT-scanning protocol to minimize the radiation dose to pediatric patients.

Association between COVID-19 burden and delays to diagnosis and treatment of cancer patients in England

BackgroundThe COVID-19 pandemic has been highly disruptive for cancer care. Here, we examined the effect COVID-19 had on performance of the 62-day Cancer Waiting Time (CWT) target set by the National Health Service (NHS) in England. MethodsData were retrospectively obtained on COVID-19 hospitalisations and CWT for NHS hospitals in England (n = 121). We produced a ‘COVID-19 burden’ to describe the proportion of each provider’s beds occupied with COVID-19 patients. COVID-19 burden was examined against CWT performance for 1st April – 30th May 2020 (Wave 1), and 1st October – 30th November 2020 (Wave 2). Two-tailed Spearman correlations were used to identify relationships between COVID-19 burden and CWT performance amongst different referral (i.e., 2-week-wait (2 W W) and internal specialist) and tumour types. Significantly correlated variables were further examined using linear regression models. ResultsCOVID-19 burden was negatively associated with the percentage of 2 W W pathway referrals that met the CWT target in Wave 1 (r= -0.30, p = 0.001) and Wave 2 (r= -0.21, p = 0.02). These associations were supported by the results from our linear regression models (B for wave 1: -0.71; 95 %CI: −1.03 to −0.40; B for wave 2: -0.38; 95 %CI: −0.68 to −0.07). No associations were found between COVID-19 burden and internal specialist referrals or tumour type. ConclusionIncreased COVID-19 burden was associated with lower compliance with CWT targets amongst urgent referrals from primary care in England. This will likely be an ongoing issue due to the backlog of patients awaiting investigations and treatment. Policy summaryAs the number of cancer referrals improve, we highlight the need for changes to primary and secondary care to manage the backlog within cancer diagnostic services to alleviate the impact of COVID-19.

Performance and cost calculation for a university ophthalmological outpatient clinic

HintergrundAllgemein gelten Hochschulambulanzen in Universitätskliniken als defizitär. In der vorliegenden Publikation wird der Ansatz unternommen, im Sinne einer Kostenträgerrechnung Umsatz und Kosten der Hochschulambulanz der Medizinischen Hochschule Hannover (MHH) zu evaluieren sowie eine Aufstellung der Arbeitsleistung zu unternehmen.Material und MethodeMithilfe der Daten des klinikeigenen Informationssystems (SAP) und einer eigenen Software (TimeElement), welche standardisiert angewendet wird, um den Patientenflow in unserer Hochschulambulanz in Echtzeit online zu erfassen, wurden alle Patientenkontakte des Jahres 2019 evaluiert. Die Gesamtkosten summieren sich aus Personal‑, Material- und Raumkosten inklusive Infrastruktur und werden den pauschalierten Erlösen nach Hochschulambulanzvertrag (HSA-Bereich) sowie weiteren Erlösen aus Konsilleistungen, Selbstzahlern, ambulantem Operieren und Kooperationsverträgen für intravitreale Injektionen (IVOMs) gegenübergestellt.ErgebnisseBei durchschnittlich 10,6 assistenzärztlichen und 3,6 fachärztlichen Stellen sowie 21 nichtärztlichen Stellen (plus 4 BUFDIs [Bundesfreiwilligendienst]) in unserer Hochschulambulanz errechnen sich 2.927.022 € Personalkosten inklusive Overhead für das Gesamtjahr. Zuzüglich der Infrastruktur (524.942 €) sowie Material- und Sachkosten einschließlich Overhead sowie interner Leistungsverrechnung (ILV) in Höhe von 258.657 € beliefen sich die Gesamtkosten in 2019 auf 3.710.621 €. Dem standen Einnahmen von 3.524.737 € aus den oben genannten Bereichen gegenüber, womit sich ein Defizit von −185.884 € (5 %) ergab. Auffallend sind die deutlich unzureichende Finanzierung der Hochschulambulanz über die Fallpauschale und die notwendige Querfinanzierung aus den Bereichen des ambulanten Operierens, der IVOMs und der Selbstzahler. Insgesamt kam es zu den regulären Sprechzeiten zu 19.453 Patientenkontakten bei 17.305 abrechenbaren Fällen. Mit n = 9943 waren der Großteil der Kontakte HSA-Besuche. Abrechenbare Fälle resultierten daraus allerdings nur in 82 % aufgrund mehrfacher Besuche pro Quartal. Die gesamte Anwesenheit betrug im Median 3,21 h (durchschnittlich 3,38 h). Durchschnittlich wurden 78 Patientenkontakte pro Arbeitstag gezählt. Dabei ergab die Analyse mittels TimeElement im Median pro Patient 2 Arztkontakte (durchschnittlich n = 1,91). Die gesamte Dauer ärztlicher Interaktionen betrug im Median 18 min (durchschnittlich 23 min). In der Funktionsdiagnostik zählten wir im Median ebenfalls 2 Interaktionen pro Patient (durchschnittlich n = 2,31), wobei die gesamten Interaktionen im Median 18 min dauerten (durchschnittlich 23 min). Insgesamt wurden innerhalb der Funktionsdiagnostik n = 37.363 Einzelleistungen im Jahr 2019 gezählt, wobei mit n = 10.888 die optische Kohärenztomographie (SD-OCT) die Hauptleistung darstellte.SchlussfolgerungenIn einer reinen Kosten‑/Umsatz-Rechnung ergibt sich an der MHH ein leicht defizitäres Ergebnis der Hochschulambulanz. Somit erscheinen die Kosten einer universitären, augenheilkundlichen Hochschulambulanz in Niedersachsen durch die direkten ambulanten Einnahmen nicht ausreichend gedeckt zu sein. Eine Beibehaltung von quartalsweisen Fallpauschalen für alle Fälle der Ambulanz würde in unserem Setting eine Honorierung von ca. 214 € notwendig machen, um die Kosten zu decken. Aktuell werden die zu niedrigen Pauschalen im HSA-Bereich von den anderen Bereichen kompensiert. Die hohe medizinische Arbeitsleistung in unserem Setting erfordert einen ebenfalls hohen Personalaufwand mit einem erheblichen Personalkostenanteil von annähernd 80 %.

Under viral attack: An orthopaedic response to challenges faced by regional referral centres during a national cyber-attack

BackgroundA national ransomware attack on the Irish Health Service Executive left the Healthcare system bereft of access to IT systems, electronic patient records, and the national imaging system. Widespread disruption to internal and external referral pathways, and both trauma and elective Orthopaedic services occurred as a result. The purpose of this paper to discuss the challenges faced by Regional trauma units and adjustments made to overcome these. MethodsIssues occurring as a result of the IT cybersecurity attack were discussed at regional level. Local and specialist centre adaptations were collated to identify effective modifications to established practice in the wake of the IT attack. ResultsThe main areas affecting Orthopaedic regional practice were identified, including internal referrals, interhospital referrals to both regional and specialist centres, outpatient clinics, and elective practice. Strategies to overcome these were collated and shared between regional centres, including the use of secure messaging systems to safely transmit relevant clinical information between services, use of radiological hard copies, and integration of imaging resources to the outpatient department to expedite clinical review. ConclusionThe national cyberattack necessitated rapid adaptations to overcome the challenges faced as a result of reduced clinical and radiological access. While the recent cyberattack highlights the vulnerability of electronic systems, and the need for vigilance including staff training on cybersecurity; Changes implemented by regional centres also illustrate the potential for further development and expansion of current clinical practices.

MRI provision for patients with cardiac implantable electronic devices: understanding the real-world administrative requirements of service delivery

Abstract Introduction Patients with cardiac implantable electronic devices (CIEDs) should have access to Magnetic Resonance Imaging (MRI) but are less likely to be referred and hospitals lack provision. A major barrier to service delivery is the administrative demand required to obtain accurate CIED details prior to scheduling. We aimed to understand the administrative requirements of a high-volume Cardiac Device-MRI service to inform the design of an electronic referrals platform that can facilitate workflow. Methods Single centre retrospective audit of a high-volume Cardiac Device-MRI service in a tertiary unit in the UK. Six months of referrals were reviewed for patient and CIED details and barriers met. Referrals were stratified by source, indication, MR-Conditional labelling and referrer. Results Administrative barriers were reviewed for 116 patients with CIEDs referred for MRI (48% cardiac, 52% non-cardiac) between September 2020 and March 2021 (Table 1). Referrers were 47% cardiologists and 53% other specialties. Referral to scan time was 15 days (interquartile range, 8–32). There were no scan-related complications. 34% of referrals contained complete CIED details and 30% stated the MR labelling of the CIED. None incorrectly labelled a CIED as MR-Conditional, but 8% incorrectly labelled as non-MR Conditional. 7 additional days were required to obtain complete CIED details where not provided (involving information requests from two device clinics in 27%), 10% had delays over 2 weeks (maximum 145 days). 35% required 3 or more repeat discussions with referrers after initial referral. Obtaining CIED information for external referrals required 17 days (11–42), compared to 14 (6–35) days for internal referrals (p=0.25). Patients with non-MR Conditional CIEDs required on average 14 days longer to obtain complete referral details than patients with MR-Conditional CIEDs. Even when referrers were aware of non-MR Conditional labelling and received information on risk, 41% required further discussion between patient and referrer regarding risks and benefits of MRI scanning. For cancer referrals, obtaining correct details took 1 day longer than other referrals (p=0.074) and required 2 extra emails to maintain provision within the national time-to-treatment target of 62 days. Missing data was similarly present in referrals from Cardiologists and non-Cardiologists (59% versus 61% respectively), but non-Cardiologists recorded more incorrect CIED details (8% vs 0%). Conclusions Referral for MRI in patients with CIEDs demands significant administrative input to obtain correct device information, leading to delays. These delays are greater for patients with non-MR conditional CIEDs, and data provided is often incorrect or incomplete. This may explain why some patients are not referred for MRI. An online referrals platform has been developed to streamline this process, initially deployed through a network of 60 centres registered in the UK. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work is supported by British Heart Foundation Innovations funding (HFHF_016).

Quality of referrals for glaucoma assessment: a cross-sectional survey of clinical data and outcomes.

This study assessed the completeness of clinical information provided by ophthalmological and optometric referrals to glaucoma specialists consulting for open-angle glaucoma (OAG). A retrospective, cross-sectional study of 72 internal referrals for evaluation of OAG in a multispecialty group practice was performed. The quality of the referral was assessed based on: (1) the completeness of the clinical triad of intraocular pressure measurement, visual field (VF), and cup-to-disk ratio for each eye; (2) the availability of the data necessary to calculate an ocular hypertension treatment study (OHTS) score; and (3) the presence of retinal nerve fiber layer (RNFL) imaging by mean of optical coherence tomography. The clinical triad was available in 57% of referrals, whereas an OHTS score was calculable in 24% of referrals (p < 0.001); RNLF imaging was available in 51% of referrals (p = 0.859). The completeness of clinical information was similar for ophthalmological and optometric referrals. From the date of referral to the time of the consultation, there was a significant increase in the availability of the clinical triad (57-65%; p = 0.013) and the OHTS score (24-5%; p = 0.004) but not for RNFL imaging (51-56%; p = 0.618). The most common missing clinical information was VF testing, which was absent in 42% of referrals. Key clinical data necessary for effective diagnosis and staging of OAG was lacking for many patients referred to glaucoma specialists.

Integrating Acupuncture into Primary Care.

Objectives: To investigate the viability of integrating acupuncture services into a Patient-Centered Primary Care Home (PCPCH) and Federally Qualified Healthcare Center (FQHC) located in a frontier community. The study had two primary aims: (1) to assess demographics, clinical characteristics, and utilization patterns of patients who accessed acupuncture services at Winding Waters Community Health Center (WWCHC), (2) to perform cost-benefit analysis using a basic revenue versus expense calculation. Design: This observational study consisted of two primary components: (1) a retrospective chart review and (2) a basic cost versus revenue assessment. Setting/Location: WWCHC, an FQHC located in frontier Northeastern Oregon. Subjects: Data from 551 charts of patients aging ≥18 years who accessed acupuncture services at WWCHC between January 2017 and December 2018. Results: Patients attended 3210 acupuncture visits. The demographics of patients utilizing acupuncture services reflected community demographics. Mean age was 54 years (±16.9) and 99 patients (18%) reported income below the federal poverty level. The prevalent chief complaint was back and neck pain (46.6% of visits). WWCHC medical providers placed 538 internal referrals for patients to receive acupuncture. Although patients are actively utilizing insurance benefits for acupuncture, reimbursement remains a challenge. Reimbursement rates ranged between 34% and 69% of billed rate. In 2018, 779 visits were paid by patients at an average rate of $48.71 per visit. Despite challenges, clinic revenue for acupuncture services exceeded costs by 4%. Conclusions: The acupuncture program at WWCHC is economically feasible and well utilized by patients. Adequate reimbursement remains a challenge, but it is not cost-prohibitive and provides a nonpharmacologic treatment option in this frontier setting. Revenue for acupuncture services exceeded costs by 4%.

Effects of a single-entry intake system on access to outpatient visits to specialist physicians and allied health professionals: a systematic review.

Background:Canada lags behind other countries with respect to wait times for specialist physician and allied health professional consultations. We conducted a systematic review to assess the effects of a single-entry model on waiting time, referral volume and the satisfaction of patients and health care providers.Methods:We searched MEDLINE, Embase, Cochrane CENTRAL and CINAHL databases from inception to December 2019. We included studies from countries in the Organisation for Economic Co-operation and Development that reported on the effects of a single-entry model on the time between referral to first assessment by a specialist physician or allied health professional, termed wait time 1 (WT1). Patient volume and the satisfaction of providers and patients were secondary outcomes. We conducted a narrative synthesis using descriptive statistics.Results:Of the 4637 citations identified, 17 met the eligibility criteria, and we included 10 of these in the final analysis. All of the included studies reported an absolute reduction in WT1 after implementation of the single-entry model. The average percent reduction in WT1 across specialties was greatest for surgical referrals (57%) and urgent internal medicine referrals (40%). Higher initial WT1 was associated with a greater absolute reduction in WT1 after implementation of the single-entry model (p = 0.002). Patient and provider satisfaction with the single-entry model was high in all studies. The effect estimates from all included studies were at high risk of bias.Interpretation:Single-entry models were associated with an absolute reduction in time from referral from primary care to consultation. These models represent a promising option to improve access to a range of health services, but there is a need for rigorous prospective evaluations to inform policy. PROSPERO Registration:CRD42018100395

Impact of Rapid Transition to Telemedicine-Based Delivery on Allergy/Immunology Care During COVID-19

BackgroundCoronavirus disease 2019 (COVID-19) necessitated wide-scale adoption of telemedicine (TM) and restriction of in-person care. The impacts on allergy/immunology (A/I) care delivery are still being studied.ObjectiveTo describe the outcomes of rapid transition to TM-based care (video visit followed by in-person visits dedicated to diagnostic and therapeutic procedures when needed) at an academic A/I practice during COVID-19.MethodsDemographic data were compared for patients originally scheduled for in-person visits between March 10, 2020, and April 30, 2020, who completed a video visit instead between March 10, 2020, and June 30, 2020, and those who did not. Appointment completion, diagnoses, and drug allergy and skin testing completion were compared for visits between March 10, 2020, and June 30, 2020, and 1 year prior (March 10, 2019–June 30, 2019).ResultsSixty-nine percent (265 of 382) of patients originally scheduled between March 10, 2020, and April 30, 2020, were able to complete video visits. Patients who completed video visits were more likely to be white (52% vs 33%; P < .001), English-speaking (96% vs 89%; P = .01), and privately insured (70% vs 54%; P = .004). With TM-based care compared with in-person care, there were significant decreases in environmental and food skin testing completion rates (91% and 92% in 2019 vs 60% and 64% in 2020, respectively, P < .001). Drug allergy testing completed after internal referral remained low but comparable (51% in 2019 vs 52% in 2020). Transitioning nonprocedural visits to video allowed allergen immunotherapy and biologic injection visits to resume at a volume similar to pre-COVID. No COVID-19 infections resulted from in-clinic exposure.ConclusionsAlthough transitioning to TM-based care allowed continued A/I care delivery, strategies are needed to achieve higher testing completion rates and ensure video visits do not exacerbate existing health disparities.

Outcomes for Cardiogenic Shock: Comparison of Patients Transferred from Outside Hospitals with Those Directly Admitted to an Advanced Heart Failure Centre

Purpose Cardiogenic shock (CS) is a complex life-threatening condition that requires timely care in advanced heart failure centres, with the ability to assess patients for ventricular assist devices (VADs) and cardiac transplantation (CT). We investigated the differences in clinical characteristics and outcomes of patients admitted to the cardiac intensive care unit (CICU) at a quaternary care institution and those transferred from outside hospitals. Methods All adult CS patients admitted between January 2014 and December 2018 were identified from the CICU registry. Patient characteristics, comorbidities, interventions and outcome data were compared between internal and external transfers. Results 799 unique patients were identified: 392 internal referrals and 407 external transfers. Those transferred from outside hospitals were younger (56+16 vs 63+17 years, p Conclusion There is a significant difference between internal referrals and external transfers for CS management. Mortality outcomes are similar, but fewer externally transferred patients receive CT and ECLS. Further investigation is warranted into barriers to referral of CS patients from external hospitals.

Lockdown low vision assessment: an audit of 500 telephone-based modified low vision consultations.

PurposeNon‐urgent face‐to‐face outpatient ophthalmology appointments were suspended in the United Kingdom in March 2020, due to the COVID‐19 outbreak. In common with other centres, Moorfields Eye Hospital NHS Foundation Trust (London) offered modified telephone consultations to new and follow‐up patients in the low vision clinic. Here we assess the success of this telephone service.MethodsData were collected for 500 consecutive telephone low vision appointments. Successful completion of the assessment and clinical outcomes (low vision aids prescribed, onward referral) were recorded.ResultsTelephone assessments were completed for 364 people (72.8%). The most common reasons for non‐completion were either no answer to the telephone call (75 people, 15%), or the patient declining assessment (20 people, 4%). There was no association between age and the likelihood of an assessment being completed. 131 new low vision aids were dispensed, 77 internal referrals were made and 15 people were referred to outside services. More than 80% of the low vision aids prescribed were useful.ConclusionsTelephone low vision assessments were completed in about three‐quarters of cases. About one‐quarter of consultations resulted in new low vision aids being dispensed, which were generally found useful. Telephone low vision assessments can be used successfully in a large low vision clinic, but have many limitations when compared to face‐to‐face assessments.

Identifying Best Implementation Practices for Smoking Cessation in Complex Cancer Settings.

Background: In response to evidence about the health benefits of smoking cessation at time of cancer diagnosis, Ontario Health (Cancer Care Ontario) (OH-CCO) instructed Regional Cancer Centres (RCC) to implement smoking cessation interventions (SCI). RCCs were given flexibility to implement SCIs according to their context but were required to screen new patients for tobacco status, advise patients about the importance of quitting, and refer patients to cessation supports. The purpose of this evaluation was to identify practices that influenced successful implementation across RCCs. Methods: A realist evaluation approach was employed. Realist evaluations examine how underlying processes of an intervention (mechanisms) in specific settings (contexts) interact to produce results (outcomes). A realist evaluation may thus help to generate an understanding of what may or may not work across contexts. Results: The RCCs with the highest Tobacco Screening Rates used a centralized system. Regarding the process for advising and referring, three RCCs offered robust smoking cessation training, resulting in advice and referral rates between 80% and 100%. Five RCCs surpassed the target for Accepted Referral Rates; acceptance rates for internal referral were highest overall. Conclusion: Findings highlight factors that may influence successful SCI implementation.

The effectiveness of the Guy\u2019s Rapid Diagnostic Clinic (RDC) in detecting cancer and serious conditions in vague symptom patients

BackgroundRapid Diagnostic Clinics (RDC) are being expanded nationally by NHS England. Guy’s RDC established a pathway for GPs and internal referrals for patients with symptoms concerning for malignancy not suitable for a site-specific 2WW referral. However, little data assessing the effectiveness of RDC models are available in an English population.MethodsWe evaluated all patients referred to Guy’s RDC between December 2016 and June 2019 (n = 1341) to assess the rate of cancer diagnoses, frequency of benign conditions and effectiveness of the service.ResultsThere were 96 new cancer diagnoses (7.2%): lung (16%), haematological (13%) and colorectal (12%)—with stage IV being most frequent (40%). Median time to definitive cancer diagnosis was 28 days (IQR 15–47) and treatment 56 days (IQR 32–84). In all, 75% were suitable for treatment: surgery (26%), systemic (24%) and radiotherapy (14%). Over 180 serious non-neoplastic conditions were diagnosed (35.8%) of patients with no significant findings in two-third of patients (57.0%).ConclusionsRDCs provide GPs with a streamlined pathway for patients with complex non-site-specific symptoms that can be challenging for primary care. The 7% rate of cancer diagnosis exceeds many 2WW pathways and a third of patients presented with significant non-cancer diagnoses, which justifies the need for rapid diagnostics. Rapid Diagnostic Centres (RDCs) are being rolled out nationally by NHS England and NHS Improvement as part of the NHS long-term plan. The aim is for a primary care referral pathway that streamlines diagnostics, patient journey, clinical outcomes and patient experience. This pilot study of 1341 patients provides an in-depth analysis of the largest single RDC in England. Cancer was diagnosed in 7% of patients and serious non-cancer conditions in 36%—justifying the RDC approach in vague symptom patients.

The Impact of COVID-19 Pandemic on Ophthalmic Referrals within a Tertiary Academic Center in Oman.

PURPOSE:To investigate the impact of coronavirus infection disease-19 (COVID-19) pandemic on ophthalmic referrals within an academic tertiary center in Oman.METHODS:Retrospective chart review of internal referrals received and evaluated by the ophthalmology department between March 1and August 31, 2020 (COVID-19 period) compared to a corresponding period in 2019 (pre COVID-19). Data included patient demographics, referral details, ocular diagnosis, intervention, and discharge plan.RESULTS:Referral volume significantly decreased by 58.2%; from 2019 prepandemic to 510 (P = 0.001), with the lowest in April and May 2020. Patient demographics did not differ significantly, but “urgent” referrals reduced by 96.2% (P < 0.001). Main reasons for referrals were reduced vision and screening in both periods. During pandemic, referrals for screening purposes increased from 30.3% to 37.9% (P = 0.013) and for reduced vision decreased from 30% to 23.3% (P = 0.021). Dry eye syndrome increased in frequency during 2020 (from 2.9% to 7.3%, P = 0.002) but cataracts and conjunctivitis both decreased (from 4.7% to 2.1%, P = 0.046 and from 2.3% to 0.3%, P = 0.013, respectively). Ocular trauma remained stable (from 0.8% to 0.3%, P = 0.456), but the proportion of chemical injuries increased by 13.7% (P = 0.025). There was a drastic decrease in interventions from 37% to 26.1% (P < 0.001) and an increase in discharge rate from 61.2% to 75.8% (P < 0.001).CONCLUSION:The impact of COVID-19 pandemic on ophthalmic referrals within a tertiary academic centre in oman referral reductions and changes in pattern and characteristics as an epiphenomenon of COVID-19 reflect the extent of impact specifically in an Omani context. This information is vital for planning proper resource utilization, the adoption of innovative care delivery, and improving referral system pathways.

A SWOT analysis of human resource management in Tamil Nadu hotel industry

Human resource management an necessary division of a business, regularly make sure the achievement of the communal relationship among employees and an organization by recognize and fulfilling the requirements of the workers commencing with staffing and enduring through their occupation. This article aims to investigate the HRM practices in hotels of Tamil Nadu. This conscientious geographic spot of India proffer human resource confronts those are exclusive to this well-liked tourist areas. The outcomes from this study display that human resources are pleased with their compensation correspondence but not with the operational conditions, and the component of staff yield rate is relatively elevated. It provides sufficient training is not time and again given by the hoteliers to create employees’ organized talents and skills. Recruitment is using method of internal referral mainly significant to high inbreeding and following other human resource problems. There is a noteworthy gap among what is predictable from new employees and the skill levels of obtainable aptitude candidates. Keywords: Satisfaction, Industrial relationship, Employee grievances, Analysis of gap.

T2 protect AD: Achieving a rapid recruitment timeline in a multi‐site clinical trial for individuals with mild‐to‐moderate Alzheimer’s disease

AbstractBackgroundPreservation or improvement in cognition in Alzheimer’s disease (AD) is a public health priority. In 2018, there were 30 drugs in phase II and III AD trials1, increasing to 50 in 20192. However, AD trial recruitment is oft‐cited as slowing down research advancements3,4. The T2 Protect AD Trial (T2), is a multi‐site, randomized, placebo controlled, 52‐week trial testing troriluzole, a glutamate modulator. T2 was designed as a proof of concept clinical trial with an estimated sample size of 336 participants.MethodT2 is coordinated by the ADCS, and includes 44 US academic and private medical clinics specialized in AD research, treatment, and care. The trial (NCT03605667) includes participants with mild‐to‐moderate AD, 50‐85 years old, stable on AD medication(s), with MMSE 14‐24 and MRI findings consistent with AD. There are no AD biomarker inclusion criteria. The trial recruitment toolkit included flyers, brochures, press release, FAQ, infographics, video, and a website. The recruitment budget was divided between the central ADCS effort and individual sites. The ADCS effort included creative design services, social media outreach, telephone prescreening, development of news stories, and advertising placement.ResultSites screened 736 individuals, randomizing 350. Fourteen sites exceeded their enrollment goal of 10 participants and the top two sites randomized 25 and 20 participants. 98% of participants were randomized during an intensively supported 10‐month rapid recruitment period, that was initiated when 21/44 sites were actively recruiting (Figure). The randomization rate, defined as the number randomized, divided by the number of active site recruitment months, ranged from 0 (1 site) to 4.0 per month, with an overall rate of 0.87 per month. Sites enrolled 75% of the cohort through their existing site recruitment infrastructure, including waiting lists and internal referrals. 25% came from news media reports, paid advertising, word‐of‐mouth, and outside physician/organizational referrals. Social media advertising was not a significant source of participants.ConclusionThis trial in mild‐to‐moderate AD achieved among the highest site recruitment rates reported in ADCS investigational new drug trials in the last 20 years. Its success was primarily achieved through site network resources, however central recruiting efforts contributed significantly.

Abstract 15340: Reducing Unnecessary Preoperative Cardiology Referral and Cost in Patients Undergoing Bariatric Surgery

Introduction: Candidates for bariatric surgery are at increased risk for cardiovascular disease, which may increase surgical risk. Currently, there are no society guidelines indicating which patients are appropriate for preoperative cardiovascular evaluation and risk stratification. Hypothesis: We hypothesized that applying a standardized surgical risk calculator with a novel multidisciplinary internal referral algorithm to stratify patients for preoperative cardiovascular evaluation would decrease unnecessary referrals and cost. Methods: All patients undergoing bariatric surgery at our institution between 2014-2018 were identified. After assessing baseline patient characteristics, referral patterns to cardiology, prevalence of cardiac testing ordered, and surgical outcomes were measured. The Revised Cardiac Risk Index (RCRI) score was retrospectively calculated for each patient and grouped as low versus increased risk (RCRI score of 0 versus ≥ 1). Imputing a post hoc referral algorithm requiring an RCRI ≥ 1, age ≥ 65, METS ≤ 4, and/or ever smoking history for cardiology referral, we calculated how referral pattern would be affected and the resultant change in referral costs. Results: A total of 797 patients underwent bariatric surgery during the study period, of which 68% (n=540) were referred to cardiology preoperatively. Those referred had more hypertension, hyperlipidemia, diabetes, smoking history, and were more likely to have BMI &gt;50 kg/m 2 . Of those referred, 81% (n=438), 15% (n=81), 3% (n=17), and 1% (n=4) had RCRI scores of 0, 1, 2, and ≥ 3, respectively. Of those patients with an RCRI score of 0, 53% (n=234) underwent further cardiac testing. Strictly applying our standardized internal referral algorithm, of the 540 patients referred to cardiology, only 45% (n=199) were appropriately referred. Based on Medicare reimbursement for Level 4 outpatient consults, this would have resulted in a savings of approximately $86,000. Conclusions: Among candidates for bariatric surgery, a novel referral algorithm based on RCRI and other cardiovascular risk factors may reduce unnecessary preoperative cardiology referrals, with resultant reduction in resource utilization and overall cost savings.

Optimizing internal referrals within an academic breast oncology practice.

48 Background: Improving new patient access to medical oncology clinics is a priority. Unlike external referrals which undergo a review process, internal referrals (from any Mayo department or community-based, affiliated health system) are scheduled directly. At times, these internal referrals lack necessary clinical information, or may be more appropriate for electronic consultation (e-consult). This impacts the patient experience, provider satisfaction, and access to new patient visits. A pilot program was implemented in the Medical Oncology breast clinic to review new internal referrals prior to scheduling. Methods: In 2018, all internally referred patients to Medical Oncology breast clinic were reviewed by an advanced practice provider in breast oncology. Electronic medical records were reviewed to collect diagnosis, pathology, radiology information and treatment to date. Internal referrals were either accepted directly to medical oncology breast clinic, triaged to an internal medicine clinic for workup of a new breast mass, converted to an e-consult, or declined as no medical oncology need was identified. Results: 52 patients were referred internally to Medical Oncology breast clinic. Of these, 29 (55.8%) were accepted directly as new consultations, 8 (15.4%) were triaged to the Internal Medicine clinic, 6 (11.5%) were converted to e-consults, and 6 (11.5%) were declined as not requiring breast medical oncology input. Of the 8 patients that started in the IM clinic, 6 eventually required Medical Oncology breast clinic consults for invasive breast cancers. The most common e-consult was for extending adjuvant endocrine therapy (3/6). 1/6 e-consults required a follow up consultation. The most common reason for declining a consult was no diagnosis of an invasive breast cancer (4/6). A total of 16/52 referrals (30.2%) did not require a breast oncology new consultation. Conclusions: Review of internal referrals improved the efficiency of new breast cancer medical oncology consultations. This review process has been implemented across the entire Medical Oncology practice.