Lessons from a web-based referral system for acute neurosurgical referrals. Part 2: Referral trends and outcomes

Background: The adoption of electronic referral systems has transformed healthcare delivery, particularly in neurosurgery, where timely referrals are crucial. Despite increasing interest, limited research exists on the demographic characteristics and referral patterns in neurosurgery. This study aims to fill this gap by analysing data from the Hospital Emergency Neurosurgical Referral Interface (HENRI) at the Royal Brisbane and Women's Hospital (RBWH).

Methods: A retrospective analysis of 3,791 referrals to the RBWH Neurosurgical Department via HENRI between February 2021 and February 2022 was conducted. Patient characteristics, provisional diagnoses, urgency classifications, decisions, procedures, and anti-thrombotic use were analysed.

Results: The majority of referrals (40%) came from within the Metro North Catchment, with trauma being the most common reason for referral (30%). Notably, a significant proportion of referrals did not necessitate neurosurgical intervention (33%). Urgency classifications often did not align with the need for transfer or surgical intervention, indicating potential overestimation of urgency. Patients transferred to RBWH were younger, with a higher proportion undergoing procedures. Antiplatelet and anticoagulant use was common, particularly in older patients with iatrogenic coagulation abnormalities.

Conclusions: Our findings highlight the need for accurate diagnosis and appropriate triaging of patients to optimize resource allocation and patient care. Improved communication between referring teams and neurosurgical services is crucial to streamline the referral process. Furthermore, addressing challenges in managing neurotrauma at peripheral sites is essential to ensure timely access to appropriate care. Future research should focus on implementing interventions to improve efficiency and effectiveness in neurosurgical referrals.