This study aims to evaluate the electronic urology referral system at the Queen Elizabeth Hospital in Birmingham (QEHB) between October 20, 2022, and January 31, 2023. The primary objectives were to assess the volume and reasons for referrals, evaluate the appropriateness of the current referral template, examine the adequacy of the information provided, and analyze the relationship between the referrer’s level of seniority and the completeness of the referrals. Additionally, the study investigated the urology team’s response times to these referrals.

This retrospective Study analyzed electronic urology referrals received by the QEHB urology department over a 104-day period. Data collected included the total volume of referrals, the specialties and levels of seniority of referrers, the reasons for referrals, the appropriateness of the referrals, and the quality of information provided. Appropriateness was assessed based on whether the referral was necessary, complete, and aligned with the urgency of the clinical need. The urology team's response times to the referrals were also recorded.

A total of 337 electronic referrals were received, averaging 3.24 referrals per day. Referral volumes peaked at 17 on January 5, 2023, with 14 days (primarily weekends) showing no referrals. General Medicine was responsible for 57% of the referrals, a significant proportion of which were deemed inappropriate. Senior House Officers (SHOs) made the majority of referrals (190), with 38% of these considered inappropriate, often due to missing necessary data or being unnecessary. Registrars, Foundation Year 1 (FY1) doctors, and consultants contributed to the referral pool, with varying rates of inappropriateness.

The most common reasons for referral were incidental scan findings (33.8%), haematuria (13%), and other miscellaneous conditions. In total, 38% of the referrals were inappropriate: 60% were deemed unnecessary, 17% lacked sufficient information, 11% were more suited for outpatient care, and the remainder required urgent or emergency attention. Furthermore, 58% of referrals were found to be inadequately detailed, missing critical clinical information or necessary investigative data.

In terms of response times, 58% of referrals were responded to within 24 hours, while 24% received no response, highlighting inefficiencies in the referral process.

The findings suggest significant shortcomings in the current referral system at QEHB. The high proportion of inappropriate referrals, particularly those made by SHOs, suggests a need for improved training and guidance on the referral process. The inadequacy of information in more than half of the referrals indicates that referrers may not be consistently providing essential clinical details, potentially complicating the urology team’s ability to triage and respond effectively. Furthermore, the delayed or absent responses to 24% of referrals point to systemic inefficiencies that may hinder timely patient care.

To address these issues, there is a clear need to refine the referral process. Recommendations include revising the referral template to include checkboxes for urgency, brief history, and relevant past medical information. Limiting referrals to SHO-level staff and above, and ensuring that referrals are specific to active inpatient admissions, could further improve both the quality and efficiency of the process.

This audit underscores the importance of refining the electronic referral system to enhance the appropriateness, completeness, and timeliness of urology consultations at QEHB. Streamlining the referral process is crucial for improving patient care outcomes and optimizing the use of healthcare resources.