Mahmoud Amer

Mahoud is a dual trainee in General Medicine and Nephrology who graduated from Otago University in 2010 and completed his basic training at Dunedin Hospital. He has worked at Waikato Hospital and Southland Hospital during his advanced training so far. His  interests include quality improvement and interventional nephrology.

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Enhancing Care For Surgical Inpatients Referred To Medicine With Acute Medical Problems

​Aims: To improve the quality of referrals and care of surgical inpatients with acute medical problems at Southland Hospital.

Methods: Staff were surveyed to establish baseline trends and gather suggestions. Demographics and admission data were recorded for surgical inpatients referred for a medical consult (baseline phase). From mid-August 2019 an electronic referral with educational flowcharts was commenced. Staff were re-surveyed in November 2019. Primary outcomes were delay time (time from referral to patient review), length of stay (LOS), 30 day mortality and 30 day readmissions.
 
Results: At baseline, 78% of medical staff rated referrals as ‘poor’. This improved to 67% ‘good’ and 17% ‘very good’ post-intervention. 100% of medical staff supported ongoing use of the electronic referral. Comparing baseline phase (n=60) to post-intervention phase (n=29), mean age (SE) 67.8 (2.6) vs 66.9 (3.2) years, males 55% vs 52%, acute admissions 92% vs 76%, inappropriate referrals 12% vs 7.7%, resus status known 12% vs. 69% and referral rate 0.5/day vs 0.6/day. Median delay time (IQR) was 89 minutes (156-37.5) vs 139 minutes (235-37) p=0.30, mean LOS 14 days (SE 2.1) vs 7 days (SE 1.30) p=0.01, median LOS (IQR) 7 days (16.8-4.3) vs 6 days (10-2) p=0.03, 30 day mortality 5% vs 0% p=0.55 and 30 day readmissions 0.22/referral vs 0.45/referral p=0.05.
 
Conclusions: An electronic referral system with educational flowcharts was associated with a significant reduction in LOS for surgical inpatients referred for a medical consult. 30 day readmissions have increased however this could be due to the smaller sample size. User feedback was positive, with unanimous support for ongoing use of the electronic referral which doubles as a platform for future audits.
 
Clinical Practise Point: We encourage medical departments to develop electronic referral systems with an educational focus to assist surgical teams in managing medical issues for their inpatients.