title: A web-based referral system for neurosurgery--a solution to our problems?
abstract: BACKGROUND
  Accurate handover is very important in the running of all modern neurosurgical units. Referrals are notoriously difficult to track and review due to poor quality of written paper-based recorded information for handover (illegibility, incomplete paper trail, repetition of information and loss of patients). We have recently introduced a web-based referral system to three of our referring hospitals.
  
  
  OBJECTIVE
  To review the experience of a tertiary neurosurgical unit in using the UK's first real time online referral system and to discuss its strengths and weaknesses in comparison to the currently used written paper-based referral system.
  
  
  METHODS
  A retrospective analysis of all paper-based referrals made to our unit in March 2009, compared to 14 months' referrals through the web system. Patterns of information recorded in both systems were investigated and advantages and disadvantages of each identified.
  
  
  RESULTS
  One hundred ninety-six patients were referred using the online system, 483 using the traditional method. Significant problems of illegibility and missing information were identified with the paper-based referrals. In comparison, 100% documentation was achieved with the online referral system. Only 63% penetrance in the best performing trust was found using the online system, with significant delays in responding to referrals.
  
  
  CONCLUSIONS
  Traditional written paper-based referrals do not provide an acceptable level of documentation. We present our experience and difficulties implementing a web-based system to address this. Although our data are unable to show improved patient care, we believe the potential benefits of a fully integrated system may offer a solution.
authors.affiliation: Department of Neurosurgery, King's College NHS Hospital Trust, London, SE5 9RS, UK. melissa.choo@doctors.org.uk
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Choo
authors.forename: Shyamica
authors.initials: S
authors.lastname: Thennakon
authors.forename: Jonathan
authors.initials: J
authors.lastname: Shapey
authors.forename: Christos M
authors.initials: CM
authors.lastname: Tolias
mesh_terms: D003142:Communication; D003195:Computer Communication Networks / Q000458:organization & administration* / Q000592:standards; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000592:standards; D004282:Documentation; D005260:Female; D006801:Humans; D008297:Male; D009493:Neurosurgery / Q000458:organization & administration* / Q000592:standards; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D006113:United Kingdom