Electronic referral systems improve documentation of hip arthroplasty MDT outcomes

Shih-Han Chen, Lina Chevalier, David Howard, Toby Briant-Evans, Geoffrey Stranks, Jamie Griffiths

Hampshire Hospitals NHS Foundation Trust

Complex hip procedures often require specialist surgeons, pre-operative planning and work-up. There is increasing literature suggesting that MDTs improve patient care.
The GIRFT, BHS and BOA guidelines recommend that MDT outcomes should clearly document the surgical indications and decisions.
We studied the impact of implementing an e-referral system to the hip MDT at a district general hospital.

Hip MDT outcomes on electronic patient records were audited against the joint standards.
During the first audit (March to June 2021), referrals were facilitated by a single MDT coordinator.
An e-referral system was integrated into EPR over Summer 2021.
A re-audit (November 2021 to February 2022) was performed to close the loop.

In the first audit, 45 cases (34 patients) were identified in 6 MDTs. Only 47% had documented outcomes.
After implementing e-referrals, the re-audit identified 55 cases (31 patients) in 7 MDTs. 85% had documented outcomes. 71% were auditable directly via the e-referral system.

The implementation of an e-referral system significantly improved the standard of documentation of hip MDT outcomes (χ2=20.2, p<0.001).
We identified the need for an e-referral system tailored for the MDT process, as our current technical implementation (based on generic inter-departmental templates) still had room for improvement.
A working group is currently exploring options for further improvement and expansion, in preparation for the regional MDT process.

– Hip MDTs should be supported by an e-referral system
– E-referral systems should be tailored for MDTs
– Appropriate support and funding for MDTs improve patient care