Development and evaluation of an electronic hospital referral system: a human factors approach.

Coordinating care across hospitals is critical to ensuring patient safety, but this can be challenging when referrals are paper-based and poorly documented. Electronic referral systems have the potential to improve this situation, but they often fail to gain uptake. To address this, a human factors/ergonomics (HFE) approach was used to develop a new regional electronic referral system, with a focus on analysing local workflow and user engagement.

The results of a before-and-after study evaluating the intervention were impressive. Referral quality improved significantly, with a rise from 36.9% to 83.5% in the proportion of referrals containing sufficient clinical information for continuation of care. The completeness of referral information also significantly improved, with a 35.7% reduction in the number of calls to the on-call specialist. The mean period between admission and surgery for expedited transfers was reduced, and the system maintained sustained uptake three years after implementation.

This study shows that applying HFE-informed design with use-based evidence can lead to a referral system that is efficient, effective, and user-friendly. The improved quality of referral information translates to better patient safety during inter-hospital transitions. Overall, this study demonstrates the benefits of taking a human-centred approach to healthcare technology development and highlights the importance of user engagement in ensuring the success of such interventions.

Woodward M, De Pennington N, Grandidge C, McCulloch P, Morgan L. Development and evaluation of an electronic hospital referral system: a human factors approach. Ergonomics. 2020 Jun;63(6):710-723. doi: 10.1080/00140139.2020.1748232. Epub 2020 Apr 28. PMID: 32220218.