Development and evaluation of an electronic hospital referral system: a human factors approach.

Coordinating care across hospital organisations has been identified as a risk factor for patient safety as referrals are often paper-based and poorly documented. Electronic referral systems have the potential to improve the situation but can fail to gain uptake. We applied a human factors/ergonomics approach to place analysis of local workflow and user engagement central to the development of a new regional electronic referral system.The intervention was evaluated with a before-and-after study to compare the quality and completeness of referral content, the efficiency of inter-hospital communication and admission to surgery time period.Referral quality improved, the percentage of referrals containing sufficient clinical information for continuation of care increased from 36.9% to 83.5% and completeness of referral information significantly improved across all fields. There was a 35.7% reduction in the number of external calls to the on-call specialist following the introduction of the system, and the mean period between admission and surgery for expedited transfer patients was reduced.Applying human factors to the development of a healthcare application informed design decisions with use-based evidence; the system maintains good uptake and sustained use three years after implementation. Improvements in the reliable recording of information across sites translates to better patient safety during inter-hospital transitions.Practitioners summary: This study developed, implemented and evaluated a clinical referral system using a human factors approach. Process analysis and usability studies were used to inform the application requirements and design. Region-wide implementation in hospitals resulted in the improved quality and completeness of clinical referral information and efficiencies in the referral process.