gms | German Medical Science

Objectives/Interrogation: NORSE is an electronic referral system where all our external hand trauma referrals are received. The referrals are then acted upon by the on-call hand team. The aim of this study was to establish the variation in management plan and advice given through NORSE in order to identify areas of improvement and address these by improving the electronic referral system.

Methods: We conducted a retrospective study of 100 referrals between July and September 2018 on the NORSE system. The diagnosis code for the referrals, information provided by the referees, advice given by our unit and management plan was collected. We then introduced an one-click electronic advice template for each diagnosis referral category and re-audited our results in another 100 patients.

Results and Conclusions: The largest number of referrals consisted of closed metacarpal fractures (24%) followed by single flexor tendon injuries (14%) and single extensor injuries (8%). Forty-seven percent of referrals were open injuries. Our primary study showed that we missed out on requesting antibiotics (19%), tetanus status (19%), washout of wound (7%) and xray to be taken (3%) respectively in cases where this was indicated. Upon re-audit these rates showed a significant improvement and decreased time of management plan formulation.

By introducing an editable advice template function in the NORSE system for each diagnosis category we were able to achieve more efficient formulation of patient management plans and standardise the treatment. We showed that incorporating assistive technology in a digital referral management system can simplify the workload for our physicians and reduce variability in essential acute management of hand injuries.