Referral relies on email: Time to transform today’s system
A story from a liver doctor. Undoctored, unfiltered, and unexaggerated.
Your patient, Hamish, had an ultrasound scan two weeks earlier while you were on leave and they found a probable renal cancer. After catching up with your backlog, you pick this up. The report reads: ‘Refer to a specialist MDT’ (multidisciplinary team).
‘Who runs the renal cancer MDT?’
You don't know.
You email your secretary to ask. Your secretary does not know, so they email the renal medical secretaries, who also doesn’t know the answer and may not reply.
A week later, you have seen 100 patients since Hamish, and by chance, you remember there’s been no response.
You chase the secretaries and a week later they tell you to email the Urology MDT Coordinator and Chair at another hospital. More emails follow.
Four weeks have passed. You’ve seen 100+ other patients. Hamish’s risk of death from cancer potentially up 10%.
You ask them how to refer and if they need any scans. Ten days on, you have seen another 100 or so patients, and realise they have not replied as they are busy, and chase again.
An email comes through asking you to request a CT chest and abdomen (a specialised X-ray) and to complete a three-page Word document referral form.
All this time, Hamish remains unaware of the developments at home or work, not aware that he may have a potential renal cancer growing each week. He gets a call; “there is an abnormality on his kidney which needs a CT scan”.
You trawl your emails and find the referral document but due to copy and paste blocks on the system, you retype 3 pages of details in between seeing your daily 20-30 patients, and chase follow-ups for other patients like Hamish. At the end, you see that it can only be submitted once the CT scan is transferred.
10 days later, the scan and report appear after checking his record in your off time. You now need to transfer the scan to the other hospital and search the directory: “radiology”, “X-ray”, “CT”, “transfer”. Nothing. You ask radiology and they tell you to search for ‘IEP’, image exchange portal – far from an obvious search term for a common procedure.
Eight weeks have passed. You’ve seen 500+ other patients. Hamish’s risk of death from cancer potentially up 20% since original detection.
The IEP transfer form involves filling in more information about Hamish manually and is sent via email to the transfer office. Someone from there copies and pastes every single piece of information from that form into a different IEP transfer request form, which is then submitted to enable the CT scans to be transferred overnight.
Finally, after 2 months, you submit the referral to the MDT. UK cancer targets recommend a full discussion within 2 weeks.
16 weeks have passed. You’ve seen 2000+ other patients. Hamish’s risk of death from cancer potentially up 40% since original detection.
The MDT will discuss him next week, but you’re not available as you are running a clinic. With no easy way for the MDT team to schedule the discussion, it is discussed in your absence.
Two days later, they email you, it is a likely renal cell cancer. You arrange to see Hamish and break the bad news. Mortified, he asks questions you can't answer because you missed his discussion. The best you can offer, is to inform him that he'll receive a consultation at the joint renal oncology/urology clinic to discuss his diagnosis and options.
Imagine if you missed the email about Hamish’s probable renal cell cancer. You receive >150 emails a day, and some will inevitably fall by the wayside.
You might think, you wouldn't miss an important email like this, but it happens often for both MDT teams and doctors. There's no simple system that keeps track of this. Everything relies on emails; a system designed to fail.
Hamish was relatively fortunate! But despite this, during his two month delay, his cancer metastasised in his lungs and he passed away three years later. Sometimes patients fall between the cracks. They get lost and are harmed. That's the world we live in.
With Dialogue and Monitor software
Sarah, a similar patient with the same predicament was lucky and her cancer had not spread. After her treatment, she has a liver ultrasound check-up for liver cancer every 6 months, organised by Salutare® Monitor.
While on holiday, you receive a special alert about a ‘serious abnormality’, a suspected renal cancer. You log on to your dashboard to see a clear red alert that takes you to Sarah’s record. You review the scan findings and quickly find the urology referral form. It pre-fills her information, medication history and past medical history.
The software reminds you, clearly, that another CT scan is needed. You make the request via a colleague. After typing in your question to the MDT to request advice for Sarah’s next steps. You press submit, knowing the software will handle the scan transfer automatically.
It has taken less than five minutes to complete the online referral.
The MDT Coordinator books the case in for two weeks, by which time the CT scan has been completed and transferred. You return from holiday and can see the detailed MDT discussion outcomes on the platform.
You arrange to see Sarah, inform her of the news and next steps, and are able to give more detailed answers to her questions. She is reviewed in the joint urology/oncology clinic the following week.
You get on with your day, knowing that Sarah is on your software dashboard with tracking functionality, and alerts and reminders sent to you as and when needed.
Better outcomes are possible with Salutare® software created by clinicians, for clinicians.