Augestad Knut Magne, Revhaug Arthur, Vonen Barthold, Johnsen Roar, Lindsetmo Rolv-Ole
Norwegian Centre for Telemedicine, Norway.
BMC Surg. 2008 Aug 11;8:14. doi: 10.1186/1471-2482-8-14.
Waiting time and costs from referral to day case outpatient surgery are at an unacceptably high level. The waiting time in Norway averages 240 days for common surgical conditions. Furthermore, in North Norway the population is scattered throughout a large geographic area, making the cost of travel to a specialist examination before surgery considerable. Electronic standardised referrals and booking of day case outpatient surgery by GPs are possible through the National Health Network, which links all health care providers in an electronic network. New ways of using this network might reduce the waiting time and cost of outpatient day case surgery.
In a randomised controlled trial, selected patients (inguinal hernia, gallstone disease and pilonidal sinus) referred to the university hospital are either randomised to direct electronic referral and booking for outpatient surgery (one stop), or to the traditional patient pathway where all patients are seen at the outpatient clinic several weeks ahead of surgery. Consultants in gastrointestinal surgery designed standardised referral forms and guidelines. New software has been designed making it possible to implement referral forms, guidelines and patient information in the GP's electronic health record. For "one-stop" referral, GPs must provide mandatory information about the specific condition. Referrals were linked to a booking system, enabling the GPs to book the hospital, day and time for outpatient surgery. The primary endpoints are waiting time and costs. The sample size calculation was based on waiting time. A reduction in waiting time of 60 days (effect size), 25%, is significant, resulting in a sample size of 120 patients in total.
Poor communication between primary and secondary care often results in inefficiencies and unsatisfactory outcomes. We hypothesised that standardised referrals would improve the quality of information, making it feasible to use a one-stop approach for all patients undergoing surgery on an outpatient basis for inguinal hernia, pilonidal sinus and gallstones. In this study we wanted to investigate the waiting time and cost-effectiveness of direct electronic referral and booking of outpatient surgery compared to the traditional patient pathway, where the patient is seen at the outpatient clinic prior to surgery.
This trial has been registered at ClinicalTrials.gov. The trial registration number is: NCT00692497.
从转诊到日间门诊手术的等待时间和费用处于令人无法接受的高水平。在挪威，常见外科疾病的平均等待时间为240天。此外，在挪威北部，人口分布在广阔的地理区域，使得手术前前往专科检查的交通成本相当高。通过国家健康网络，全科医生可以进行电子标准化转诊并预约日间门诊手术，该网络将所有医疗服务提供者连接在一个电子网络中。利用这个网络的新方法可能会减少日间门诊手术的等待时间和成本。
在一项随机对照试验中，被转诊至大学医院的选定患者（腹股沟疝、胆结石病和藏毛窦）被随机分配至直接电子转诊并预约门诊手术（一站式），或采用传统患者路径，即所有患者在手术前几周在门诊就诊。胃肠外科顾问设计了标准化转诊表和指南。设计了新软件，使得在全科医生的电子健康记录中实施转诊表、指南和患者信息成为可能。对于“一站式”转诊，全科医生必须提供有关特定病情的强制性信息。转诊与一个预约系统相连，使全科医生能够预约医院、门诊手术的日期和时间。主要终点是等待时间和费用。样本量计算基于等待时间。等待时间减少60天（效应量），即25%，具有显著性，因此总共需要120名患者作为样本量。
初级保健和二级保健之间沟通不畅往往导致效率低下和结果不尽人意。我们假设标准化转诊将提高信息质量，使对所有接受腹股沟疝、藏毛窦和胆结石门诊手术的患者采用一站式方法成为可行。在本研究中，我们想调查与传统患者路径相比直接电子转诊并预约门诊手术的等待时间和成本效益，传统患者路径是患者在手术前在门诊就诊。
本试验已在ClinicalTrials.gov注册。试验注册号为：NCT00692497。
