Aim:
Older patients may require a period of rehabilitation with GEM following hospitalisation. Robust referral pathways allow seamless transition of care. The aim was to improve communication between medical teams and access to GEM in a rural hospital in Victoria using electronic referrals.
Methods
Electronic Medical Record (EMR) software was used to create electronic referrals to be submitted by medical teams, supported by Discharge Support Liaison (DSL). Data was collected from August 2024 to January 2025; 1 month prior to the intervention, and 5 months after, with regular stakeholder feedback meetings.
Results
123 referrals were received for 99 patients admitted to Warrnambool Base Hospital from 21 different locations over 6 months. The median age was 83 years. 35% of patients were accepted to GEM on initial review. 62% of patients seen were accepted within 24 hours. The proportion of suitable referrals increased from 50% to 63%, 2 months after the intervention but this decreased to 44%, 3 months later. The most common barriers were related to allied health and medical treatment or intervention. Despite the use of the electronic referral system, total LOS increased from 24.5 to 31 days. Stakeholder feedback suggested education of rotational medical staff regarding criteria for acceptance to the GEM program and integration of DSL is required.
Conclusion
The implementation of the electronic referral system facilitated improved communication between medical teams and timely review of suitable patients. Further education and collaboration with a multidisciplinary team is required to improve the efficiency of the referral process.