Telephone Referral Research Articles

Acute internal medicine physicians' clinical intuition based on acute care telephone referral: A prospective study.

In the Netherlands, most emergency department (ED) patients are referred by a general practitioner (GP) or a hospital specialist. Early risk stratification during telephone referral could allow the physician to assess the severity of the patients' illness in the prehospital setting. We aim to assess the discriminatory value of the acute internal medicine (AIM) physicians' clinical intuition based on telephone referral of ED patients to predict short-term adverse outcomes, and to investigate on which information their predictions are based. In this prospective study, we included adult ED patients who were referred for internal medicine by a GP or a hospital specialist. Primary outcomes were hospital admission and triage category according to the Manchester Triage System (MTS). Secondary outcome was 31-day mortality. The discriminatory performance of the clinical intuition was assessed using an area under the receiver operating characteristics curve (AUC). To identify which information is important to predict adverse outcomes, we performed univariate regression analysis. Agreement between predicted and observed MTS triage category was assessed using intraclass and Spearman's correlation. We included 333 patients, of whom 172 (51.7%) were referred by a GP, 146 (43.8%) by a hospital specialist, and 12 (3.6%) by another health professional. The AIM physician's clinical intuition showed good discriminatory performance regarding hospital admission (AUC 0.72, 95% CI: 0.66-0.78) and 31-day mortality (AUC 0.73, 95% CI: 0.64-0.81). Univariate regression analysis showed that age ≥65 years and a sense of alarm were significant predictors. The predicted and observed triage category were similar in 45.2%, but in 92.5% the prediction did not deviate by more than one category. Intraclass and Spearman's correlation showed fair agreement between predicted and observed triage category (ICC 0.48, Spearman's 0.29). Clinical intuition based on relevant information during a telephone referral can be used to accurately predict short-term outcomes, allowing for early risk stratification in the prehospital setting and managing ED patient flow more effectively.

285 Trends in Emergency General Surgery activity in a dedicated unit: impact of a 5-consultant EGS team over a 3-year period

Abstract Aims A 5-Consultant EGS team was established for all acute General Surgery admissions to a 900-bed DGH. The aim was to evaluate management, outcomes and trends over a period of almost 4 years, incorporating the COVID-19 pandemic period. Methods Data was collected prospectively between 01/04/2019 & 09/01/2023 and included number and source of admissions, admission decision, surgery rates and lengths of stay. Three separate time periods were compared: (A) an 11-month pre-pandemic period (B) the official pandemic lockdown period (Mar 2020-Dec 2021) (C) a 12-month post-pandemic period. Results Direct GP-to-Consultant telephone referral was mandatory from the start of Period B, with around 200 calls/month, resulting in significant reductions in admission rates. Median weekly admissions for Periods A, B & C were 158, 127 & 132, respectively. Corresponding mean proportions coming from Primary Care vs Emergency Department were 55% vs 31.5%, 38.1% vs 46% & 39.9 vs 41%, respectively. Data since 06/12/2021 shows that 61.6% of admissions were seen by an EGS Consultant within 4 hours. The mean proportions of patients undergoing surgery during the three periods were 19.8%, 18% and 19.2%, respectively. Median length of stay (data available after Mar 2022) was 5 days. Conclusions A dedicated Consultant-led EGS service with GP collaboration is associated with improved efficiency, a reduction in GP admission rates, short hospital stays and greater use of ambulatory care. Despite fewer pandemic admissions, there was no significant change in the proportion requiring surgery, reflecting appropriateness of patient selection. Regular data analysis allows service modification responsive to needs.

Telephone Referral to a Paediatric Emergency Department: Why Do Parents Not Show Up?

Medical call centres can evaluate and refer patients to an emergency department (ED), a physician or provide guidance for self-care. Our aim was (1) to determine parental adherence to an ED orientation after being referred by the nurses of a call centre, (2) to observe how adherence varies according to children's characteristics and (3) to assess parents' reasons for non-adherence. This was a prospective cohort study set in the Lausanne agglomeration, Switzerland. From 1 February to 5 March 2022, paediatric calls (<16 years old) with an ED orientation were selected. Life-threatening emergencies were excluded. Parental adherence was then verified in the ED. All parents were contacted by telephone to respond to a questionnaire regarding their call. Parental adherence to the ED orientation was 75%. Adherence decreased significantly with increasing distance between the place the call originated and the ED. The child's age, sex and health complaints within calls had no effect on adherence. The three major reasons for non-adherence to telephone referral were: improvement in the child's condition (50.7%), parents' decision to go elsewhere (18.3%) and an appointment with a paediatrician (15.5%). Our results offer new perspectives to optimise the telephone assessment of paediatric patients and decrease barriers to adherence.

What is the most effective way to ensure that patients successfully undergo germline testing for prostate cancer?

We sought to identify the most effective way to refer patients with prostate cancer to germline testing. After IRB approval, we queried the electronic medical records (EMR) to identify patients (ages 18-89) with prostate cancer who were referred for or offered germline testing for prostate cancer from May 1, 2019 to February 24, 2021 through either telephone referral, EMR referral or in-office testing. The 3 cohorts were compared on receipt of testing and time to testing. Multivariate logistic regression and Cox regression evaluated the influence of referral cohort and reason for testing on receipt of testing and time to testing, respectively. A total of 184 patients met study inclusion criteria; 47 were referred for germline testing via telephone, 70 were referred through the EMR and 67 were offered testing in the office. No significant demographic or clinical differences were observed. Telephone referral yielded the lowest response (17%; P < 0.001) with the longest time interval between referral and testing (103 days; P < 0.001); in-office testing yielded the highest response (66%). More patients were referred because of both family history and high risk characteristics in the EMR and in-office testing cohorts (21.4% and 25.4% respectively). Referral method was significantly (P < 0.001) associated with receipt of test, while reason for testing was not. Referral method was also independently related to time to testing (P < 0.001) while reason for referral was not. Urologists should offer germline testing in the office for the most effective and expedient results.

Kick-starting youth wellbeing and access to mental health care: Efficacy of an integrated model of care within a junior sports development program

One productive avenue for building adolescents' personal strengths and reducing mental health problems is integrating assessment and intervention into organised sports programs. We investigated the efficacy of the RISE program, a rugby league development program for 12- to 15-year-old boys, which integrated a mental health and wellbeing system called Life-Fit-Learning. The Life-Fit System is designed to measure youth's strengths and mental health symptoms and sends mental health feedback to parents, provides group-based workshops, connects youth and parents to online psychoeducation resources, and provides individual telephone follow-up and referral with parents of youth at high-risk for mental health problems. In this study, mental health and wellbeing outcomes were compared in participants who did (RISE, N = 94) and did not (Comparison, N = 82) receive the RISE/Life-Fit-Learning program. RISE players reported their self-satisfaction, grit, gratitude, prosocial behaviour, anxiety, depression, and behavioural problems using the Life-Fit System pre- and post-program. Comparison participants completed measures twice, 6-months apart. Self-satisfaction did not change in RISE participants but declined among comparison participants. In both groups, 26% of players scored in the high-risk range on at least one mental health measure. On mental health measures, high-risk RISE players' depression and behavioural problems improved from pre-to post-program relative to no change among Comparison players. Among participants who were not high-risk, RISE players' anxiety, depression, and behavioural problems did not change whereas Comparison players' behavioural problems increased significantly. Results underscore the value of integrating strengths-based interventions and targeting youth mental health problems within the context of junior sports development programs.

Pathways to the emergency department - a national, cross-sectional study in Sweden

BackgroundSwedish Emergency Departments (EDs) see 2.6 million visits annually. Sweden has a strong tradition of health care databases, but information on patients’ pathways to the ED is not documented in any registry.The aim of this study was to provide a national overview of pathways, degree of medical acuteness according to triage, chief complaints, and hospital admission rates for adult patients (≥18 years) visiting Swedish EDs during 24 h.MethodsA national cross-sectional study including all patients at 43 of Sweden’s 72 EDs during 24 h on April 25th, 2018. Pathway to the ED, medical acuteness at triage, admission and basic demographics were registered by dedicated assessors present at every ED for the duration of the study. Descriptive data are reported.ResultsA total of 3875 adult patients (median age 59; range 18 to 107; 50% men) were included in the study. Complete data for pathway to the ED was reported for 3693 patients (98%). The most common pathway was self-referred walk-in (n = 1310; 34%), followed by ambulance (n = 920; 24%), referral from a general practitioner (n = 497; 1 3%), and telephone referral by the national medical helpline “1177” (n = 409; 10%). In patients 18 to 64 years, self-referred walk-in was most common, whereas transport by ambulance dominated in patients > 64 years.Of the 3365 patients who received a medical acuteness level at triage, 4% were classified as Red (Immediate), 18% as Orange (very urgent), 47% as Yellow (Urgent), 26% as Green (Standard), and 5% as Blue (Non-Urgent).Abdominal or chest pain were the most common chief complaints representing approximately 1/3 of all presentations.Overall, the admission rate was 27%. Arrival by ambulance was associated with the highest rate of admission (53%), whereas walk-in patients and telephone referrals were less often admitted.ConclusionSelf-referred walk-in was the overall most common pathway followed by ambulance. Patients arriving by ambulance were often elderly, critically ill and often admitted to in-patient care, whereas arrival by self-referred walk-in was more common in younger patients.

Barriers and Benefits of the Scheduled Telephone Referral Model (DETELPROG): A Qualitative Approach.

The recently developed scheduled mobile-telephone referral model (DETELPROG) has achieved especially important results in reducing waiting days for patients, but it has been decided to explore what barriers and positive aspects were detected by both primary care physicians (PCPs) and hospital attending physicians (HAPs) regarding its use. For this, a qualitative descriptive study was carried out through six semi-structured interviews and two focus groups in a sample of eleven PCPs and five HAPs. Interviews were carried out from September 2019 to February 2020. Data were analysed by creating the initial categories, recording the sessions, transcribing the information, by doing a comprehensive reading of the texts obtained, and analysing the contents. The results show that DETELPROG gives the PCP greater prominence as a patient’s health coordinator by improving their relationship and patient safety; it also improves the relationship between PCP and HAP, avoiding unnecessary face-to-face referrals and providing safety to the PCP when making decisions. The barriers for DETELPROG to be used by PCP were defensive medicine, patients’ skepticism in DETELPROG, healthcare burden, and inability to focus on the patient or interpret a sign, symptom, or diagnostic test. For HAP, the barriers were lack of confidence in the PCP and complexity of the patient. As a conclusion, DETELPROG referral model provides a lot of advantages and does not pose any new barrier to face-to-face referral or other non-face-to-face referral models, so it should be implemented in primary care.

Tailored intervention to implement the management of hypertensive and type 2 diabetes mellitus patients in community pharmacies – a pilot study

Abstract Introduction Uncontrolled blood pressure and poor glycaemic control may lead to increased morbidity and mortality (1). A systematic review of 40 studies reported beneficial effects of interventions conducted in community pharmacies in the management of diabetes and cardiovascular diseases (2). Aim To evaluate the impact of a tailored intervention on clinical outcomes in the management of hypertensive and/or type 2 diabetes mellitus (T2DM) patients in community pharmacies in a pilot implementation study. Methods The study (April to July 2019) utilized a mixed-method design. This included a cross-sectional survey among 133 consented community pharmacists and 390 T2DM and/or hypertensive patients at the pharmacies. Thirty-one item (pharmacists) and 29-item (patients) semi-structured questionnaires were used to gather information on their perception of pharmacists’ roles in the management of T2DM and/or hypertension. Barriers to implement identified roles by the pharmacists were documented. Thereafter, a prospective before- and after-intervention study was conducted in four consented pharmacies to address the barriers. Two pharmacists per pharmacy and 34 consented T2DM and/or hypertensive adult patients who had been on medications for ≥3 months participated. Pharmacists were provided with 2-hr one-on-one training on the management of T2DM and hypertension based on standard guidelines pre-intervention and at 4 weeks. Components of the pharmacist’s intervention included patient’s education, medication counselling , lifestyle modifications and self-care use of point of care devices. Systolic and diastolic blood pressure (SBP and DBP), fasting blood glucose (FBG) and body mass index (BMI) of all patients were measured at baseline, 4- and 8-week post-intervention. Weekly patient follow-up visits to the pharmacies were mandatory. Telephone calls and referral were incorporated, when necessary. Failure to show up for two consecutive visits disqualified patients from completing the study. Descriptive statistics (to summarise data), and paired t-test to compare mean differences in the measured parameters at α=0.05. Results Hypertensive and/or T2DM patients (374) and 71 pharmacists participated in the survey. The patients expected pharmacists to provide medication counselling (81;27.1%), education (47;12.6%), follow-up (18;4.8%), health outcomes monitoring (17;4.5%), and collaboration with physicians (12;3.2%). Sixty-nine (97.2%) pharmacists agreed that patients’ follow-up, patient counselling (71;100.0%), therapeutic plan design to achieve goals (67;94.4%) and collaboration with physicians (61;85.9%) were important. Barriers to providing adequate counsel to these patients were time constraints (23;32.4%), unconducive environment (7;9.9%) and patient’s impatience (33;46.5%). For the intervention component, 16 of the 34 patients enrolled were lost to follow-up (one hospitalized, seven failed two consecutive visits, and eight lost to referral). Effects of the tailored intervention on the parameters are in Table 1. Conclusion The patients’ and pharmacists’ perceived roles of the pharmacist in the management of hypertension and T2DM were in tandem. The 8-week tailored pharmacists’ intervention resulted in better control of blood pressure but increased FBG. This pilot study is limited by the small sample size of patients and pharmacists, as well as the lack of appropriate comparator. Future large-scale multi-site study with relevant comparator is required for a far-reaching conclusion on the impact of the tailored pharmacist intervention in the management of diabetes and hypertension.

Evaluating telephone and online psychological support and referral

Mental health counselling and support over the telephone or internet is increasingly common. Evaluating effectiveness requires outcome measures and understanding factors driving behaviour. This article describes a theory-driven evaluation of the one-month outcomes of a short-term solution-focused support session for anxiety or depression with a counsellor. The primary aim of the evaluation was to measure the outcomes of this session on service users’ help-seeking behaviour. It also sought to understand reasons for behaviour based on behaviour change theory. A secondary aim was to measure changes in feelings of stress and coping before and after the session, and collect evidence of the value of the service in terms of ‘consumer-defined recovery’. The evaluation found the service was effective, with the overwhelming majority taking some action, being more engaged with a health professional, having reduced feelings of distress, increased confidence to cope and less hopelessness. Improvements for service users included ‘reality testing’ the advice given and building commitment or intent to follow the advice, and ‘rehearsing’ so service users can demonstrate to themselves they have the skills required and can overcome any obstacles to following the advice.

Using a Combination Approach in Imparting Effective Telephone Referral Skills to Emergency Medicine Residents in Qatar: A Pilot Study.

BackgroundAppropriate and timely feedback is essential in improving communication skills and is endorsed as a core competency of emergency medicine residency (EMR) education by the Accreditation Council for Graduate Medical Education.AimThe study aimed to improve the telephone referral skills through a structured feedback session using ISBAR and to gauge residents’ opinions about this approach.MethodsThis was a pilot, educational project that included emergency medicine residents in current training program from October 2018 to March 2019. A senior faculty observed and audiotaped the telephone referral of the residents during a clinical shift. Personalized feedback was provided immediately after the consultation based on the ISBAR tool. The resident’s opinion was transcribed by the faculty.ResultsSeventeen residents agreed to participate, but 14 (3 female and 11 male) were able to complete the study. Three residents, all male, could not complete the study due to busy clinical shifts. Thirteen (out of 14) really liked this method of feedback “eye opener”, “really helped me to reflect” and 10 indicated to self-record some of their future consultations for self-improvement. Thirteen preferred this form of feedback as compared to conventional feedback. One resident disliked this approach as she was extremely nervous during direct observation and audio recording.ConclusionA combination approach of direct observations and audio recordings may be a useful pedagogy in teaching effective telephone referral skills to ED residents.

DETELPROG Study. Effectiveness of a New Model of Scheduled Telephone Referral from Primary Care to Internal Medicine. A Randomised Controlled Study.

In Spain, the average waiting time for a specialist consultation is 58 days. A determinant factor that contributes to this situation is the poor communication between primary care and specialised care, which is mainly due to the waiting days for a consultation, number of avoided/avoidable face-to-face referrals, and waiting days for the resolution of the process. DETELPROG is a referral system in which the family physician requests a scheduled outpatient internal medicine consultation, integrated into the usual consultations agenda of both physicians, the family, and the outpatient clinic physician, in order to have a telephone consultation. A randomized controlled clinical trial has been carried out to assess the effectiveness of DELTELPROG. In a sample of 255 patients, the experimental group was referred via a scheduled telephone call, and those in the control group, by face-to-face hospital consultation area. The results showed statistically significant differences between both groups of 27 days (95% confidence interval (CI): 20–33) regarding specialised consultation, 47 days (95% CI: 17–74) as for the resolution of the process, and 91.7% for avoided face-to-face consultations. The DETELPROG resulted as a low coverage system (53%), which makes it a complementary referral model. It is necessary to make an in-depth analysis of the causes that have led to this technologically low coverage.

Efectividad de un nuevo modelo de derivación telefónica compartida entre atención primaria y atención hospitalaria

AimThe purpose of this study is to find out whether telephone referral from Primary Health Care to Internal Medicine Consult manages to reduce waiting days as compared to traditional referral. This study also aims to know how acceptable is the telephone referral to general practitioners and their patients. DesignNo blind randomized controlled clinical trial. SettingNorthern Huelva Health District. Participants154 patients. InterventionsPatients referrals from intervention clinicians were sent via telephone consultation, whereas patients referrals from control clinicians were sent by traditional via. MeasurementsNumber of days from referral request to Internal Medicine Consult. Number of telephone and traditional referrals. Number of doctors and patients denied. Denial reasons. ResultsA statistically significant difference was found between groups, with an average of 27 (21-34) days. Among General Practitioners, 8 of the first 58 total doctors after randomization and, subsequently, 6 of the 20 doctors of the test group refused to engage in the trial because they considered “excessive time and effort consuming”. 50% of patients referred by the 14 General Practitioners finally randomized to the intervention group were denied referral by telephone due to patient's complexity. ConclusionsTelephone referral significantly reduces waiting days for Internal Medicine consult. This type of referral did not mean an “excessive time and effort consuming” to General Practitioners and was not all that beneficial to complex patients

A Triangulated Qualitative Study of Veteran Decision-Making to Seek Care During Heart Failure Exacerbation: Implications of Dual Health System Use.

Among Veterans, heart failure (HF) contributes to frequent emergency department visits and hospitalization. Dual health care system use (dual use) occurs when Veterans Health Administration (VA) enrollees also receive care from non-VA sources. Mounting evidence suggests that dual use decreases efficiency and patient safety. This qualitative study used constructivist grounded theory and content analysis to examine decision making among 25 Veterans with HF, for similarities and differences between all-VA users and dual users. In general, all-VA users praised specific VA providers, called services helpful, and expressed positive capacity for managing HF. In addition, several Veterans who described inadvertent one-time non-VA health care utilization in emergent situations more closely mirrored all-VA users. By contrast, committed dual users more often reported unmet needs, nonresponse to VA requests, and faster services in non-VA facilities. However, a primary trigger for dual use was VA telephone referral for escalating symptoms, instead of care coordination or primary/specialty care problem-solving.

Long-term abstinence and predictors of tobacco treatment uptake among hospitalized smokers with serious mental illness enrolled in a smoking cessation trial.

Hospital patients with serious mental illness (SMI) have high rates of smoking. There are few post-discharge treatment models available for this population and limited research on their treatment uptake following discharge. This study is a secondary analysis of an RCT that compared multi-session intensive telephone counseling versus referral to state quitline counseling at two safety net hospitals in New York City. For this analysis, we selected all trial participants with a history of schizophrenia, schizoaffective disorder or bipolar disorder (N=384) and used multivariable logistic regression to compare groups on self-reported 30-day abstinence at 6months and to identify patient factors associated with use of tobacco treatment. Analyses found no significant group differences in abstinence 6months (28% quitline vs. 29% intervention, p>0.05), use of cessation medications (42% quitline vs. 47% intervention, p>0.05) or receipt of at least one counseling call (47% quitline vs. 42% intervention, p>0.05). Patients with hazardous drinking (p=0.04) or perceived good health (p=0.03) were less likely to use cessation medications. Homeless patients were less likely to use counseling (p=0.02). Most patients did not use cessation treatment after discharge, and the intensive intervention did not improve abstinence rates over quitline referral. Interventions are needed to improve use of cessation treatment and long-term abstinence in patients with SMI.

Prehospital Glasgow Coma Score Predicts Emergent Intervention following Helicopter Transfer for Spontaneous Subarachnoid Hemorrhage

Helicopter transport may shorten transport time to neurosurgical intervention; however, there are few data regarding its utility for nontraumatic emergencies. Prehospital and hospital records of all patients transferred via helicopter to Dartmouth-Hitchcock Medical Center for spontaneous subarachnoid hemorrhage between January 2007 and December 2011 were reviewed. Primary outcome measure was emergent tertiary-level care intervention, defined as ventriculostomy, conventional angiography, endovascular treatment, or craniotomy within 3 hours of arrival. Fifty-one patients met inclusion criteria. Median helicopter transport time, defined as time from telephone referral to arrival, was 97 minutes (range, 61-214 minutes). Fifteen patients underwent intervention within 3 hours of arrival (29%), 19 patients underwent intervention between 3 and 6 hours (37%), 9 patients underwent intervention between 6 to 12 hours (18%), and 11 patients underwent intervention greater than 12 hours after arrival (16%). Univariate analysis of pretransfer clinical and radiographic findings showed significant correlations between Glasgow Coma Scale (GCS) score less than 15 (odds ratio [OR], 22.8; 95% confidence interval [CI], 4.2-122.5), World Federation of Neurologic Surgeons (WFNS) scale greater than 2 (OR, 46.75; 95% CI, 7.511-290.99), presence of intraparenchymal hemorrhage (OR, 4.7; 95% CI, 1.3-17.5), and intubation (OR, 12.4; 95% CI, 2.9-51.8) with emergent intervention. On logistic multivariate regression analysis, GCS score less than 15 and WFNS scale score greater than 2 independently predicted emergent intervention. A majority of patients with spontaneous subarachnoid hemorrhage who were transferred by interfacility helicopter ambulance did not require emergent intervention. GCS score less than 15 at an outside hospital was independently associated with emergent intervention on multivariate analysis.

Impact of a brief telephone referral on quitline use, quit attempts and abstinence.

Quitline use can prompt quit attempts and promote abstinence among smokers, but rates of use are low and outcomes of brief quitline referrals unclear. In this study, a brief intervention was delivered to smokers who expressed motivation to quit in the next 30 days (N = 221) to encourage use of their state quitline. Correlates of quitline use were examined, and quitline callers versus non-callers were compared on the following outcomes at 2-month follow-up: cessation medication use, quit attempts and abstinence. Of the 221 smokers given a quitline referral, 34% called the quitline. Baseline motivation alone distinguished quitline callers from non-callers. Quitline use was positively associated with use of cessation medication, an association that remained robust even after adjusting for baseline motivation to quit. A trend was observed in which callers were marginally more likely than non-callers to report both a 24-h quit attempt and 7-day point prevalence abstinence. Relative to non-callers, callers also endorsed greater confidence to quit and increased self-efficacy to resist smoking temptations at follow-up. This study demonstrates a minimal intervention can promote acceptance of quitlines and favorable cessation outcomes among smokers motivated to quit.

An evaluation of the referral process in the emergency department

IntroductionMaking an effective telephone referral is an important skill for an emergency department (ED) clinician. It is essential for patient safety that the information is conveyed in a succinct manner...

Advancing Collaborative Research with 2-1-1 to Reduce Health Disparities: Challenges, Opportunities, and Recommendations

The 2-1-1 system is a Federal Communications Commission nationally designated 3-digit telephone information and referral (IR track utilization of health services; and provide evidence-based information, referral, and behavioral interventions to vulnerable segments of the population. The papers in this supplement to the American Journal of Preventive Medicine 1–17 bring together an emerging body of research conducted in the context of the 2-1-1 system and highlight the exciting opportunities for collaborations between researchers and these systems. This foundation is drawn on to outline a path for moving forward to systematically and strategically realize this potential. In particular, there is a need to (1) utilize theoretical and conceptual frameworks to better place 2-1-1 in the larger public health context and show linkages between/among other public health organizations. Next, tackling differences among data systems across 2-1-1 systems arguably

Telephone referrals by junior doctors: a randomised controlled trial assessing the impact of SBAR in a simulated setting

ObjectiveTo determine whether exposing junior doctors to Situation, Background, Assessment, Recommendation (SBAR) improves their telephone referrals. SBAR is a standardised minimum information communication tool.MethodsA randomised controlled trial with participants and...

Telephone referral education, and evidence of retention and transfer after six-months

BackgroundEffective communication between clinicians is essential for safe, efficient healthcare. We undertook a study to determine the longer-term effectiveness of an education session employing a structured method to teach referral-making skills to medical students.MethodsAll final year medical students received a forty-five minute education intervention consisting: discussion of effective telephone referrals; video viewing and critique; explanation, demonstration and practice using ISBAR; provision of a memory aid for use in their clinical work. Audio recordings were taken during a subsequent standardised simulation scenario and blindly assessed using a validated scoring system. Recordings were taken immediately before (control), several hours after (intervention), and at approximately six months after the education. Retention of the acronym and self-reports of transfer to the clinical environment were measured with a questionnaire at eight months.ResultsReferral clarity at six months was significantly improved from pre-intervention, and referral content showed a trend towards improvement. Both measures were lower than the immediate post-education test. The ISBAR acronym was remembered by 59.4% (n = 95/160) and used by the vast majority of the respondents who had made a clinical telephone referral (n = 135/143; 94.4%).ConclusionsA brief education session improved telephone communication in a simulated environment above baseline for over six months, achieved functional retention of the acronym over a seven to eight month period and resulted in self reports of transfer of the learning into practice.