Ireland has the lowest number of Consultant Neurologists per capita in Europe, resulting in long waiting lists, overbooked clinics, unnecessary emergency department presentations and patient frustration.
However, results from a review of a web-based referral system, published in the October edition of the Irish Medical Journal, show a very positive solution to an overburdened health system.
The system, known as ‘Neurolink’, is the brainchild of Prof Niall Tubridy, Consultant Neurologist at St Vincent’s University Hospital, who developed the new system with the assistance of Healthlink and the IT Department at St Vincent’s Hospital.
The results of this referral system between GPs and consultant neurologists has shown a reduction in waiting lists, overbooked clinics, unnecessary emergency department presentations and the number of patients attending hospital clinics.
“Launched in 2006, Neurolink is receiving a significant interest from other consultants in many other specialities. GPs who have used the system have also indicated they would like web-based referrals to be extended to other specialties such as rheumatology, dermatology, ENT and gastroenterology. However, limited IT support structures are preventing a very successful project being rolled out nationally,” said Prof Tubridy.
Explaining the methodology of the analysis detailed in their paper — the lead author on which was Dr Laura Williams — Prof Tubridy said: “The referrals are between December 2006 and January 2011. In the first instance, GPs fill out an electronic form and data about the patient.
“The completion of the referral form took, on average, three minutes to complete. The neurologist then logs on and views the referral and sends a reply via the web application, offering advice or indicating that the patient needs further investigation.
“Almost 20 per cent of the patients referred via Neurolink did not require a neurology outpatient appointment and were managed by providing advice to the GP. Without Neurolink, these patients would have been allocated an outpatient slot. Over 3,100 new patients are seen in the neurology clinics in SVUH annually. Neurolink, therefore, has the potential to make an additional 610 new patient clinic slots available each year.”
Prof Tubridy accepted that a natural concern was that of patient safety and the possibility of missing a serious condition or mismanaging a patient as a result of not seeing them in the clinic.
“GPs are advised to re-refer patients if symptoms or signs change and have a neurology outpatient appointment arranged urgently. Studies to date have shown that email triage is safe and effective, but clinical judgment must always err on the side of caution and assess the patient in Neurology outpatients, if any doubt.”
He added that all GPs surveyed preferred the system to ‘regular mail’ referrals and all would like to see electronic referrals extended to other specialties.
“Many GPs stated that an area of particular satisfaction was the quick response time from the consultant neurologists and the opportunity for timely management advice,” he explained. The average time taken for a consultant to reply to a GP referral was 19 hours, 8 minutes.
Prof Tubridy noted: “Expan-ding the process of web-based referral developed by Neurolink is now a priority in the national cancer strategy and many other specialties are interested in its application.”
IMJ, Vol 105, No 9, pp 301-303.