The impact of direct consultant-to-consultant referrals on the spinal care pathway: A clinical audit.

Background: The institution in focus is a tertiary referral centre for all spinal pathology in the country. Traditionally, referrals to this centre have been reviewed by an on-call resident at the referring hospital. However, on May 10, 2023, this changed to a direct consultant-to-consultant referral protocol. This study aims to evaluate the impact of this change in protocol on the spinal care pathway.

Methods: A retrospective review was conducted based on patients with spinal pathology referred to the tertiary centre from February 2023 to August 2023. Referrals made using the traditional referral system ('Before' from 08/02/2023-09/05/2023) were compared to referrals made through the consultant-led referral system ('After' from 10/05/2023-08/08/2023). Parameters such as the number of referrals, number of surgically managed patients, and patients with complete imaging at the time of referral (TOR) were statistically compared between the groups.

Results: There were 31.2 % fewer referrals in the 'After' group (223) than in the 'Before' group (324). The proportion of patients with complete imaging at TOR increased significantly (67.3 % vs. 81.6 %, p < 0.05). Also, the number of patients who were treated surgically increased significantly (33.3 % vs. 40.4 %, p < 0.05). Furthermore, the number of patients referred for follow-up to the outpatient department (OPD) decreased significantly (5.2 % vs. 0.9 %; p < 0.05).

Conclusion: The consultant-to-consultant referral protocol decreased the overall referral numbers, increased the number of patients with complete imaging, increased the surgical yield, and decreased the rates of OPD follow-up. This can be attributed to more efficient consultant-led local decision-making, which fortifies the benefits of this referral protocol.