Implementation of hospital-wide referral management by triage of non-urgent primary care referrals and experiences of specialists and general practitioners: a mixed methods study

IntroductionIn the Netherlands, referral rates from primary to secondary care are rising due to an ageing population and complex healthcare needs, a challenge compounded by an on-going decline in the number of trained healthcare professionals. In this context, triage has shown promise in optimizing secondary care consultations. This hospital-wide study aimed to assess to what extent triaging non-emergent primary care referrals prevents outpatient consultations, as well as experiences of triage implementation by medical specialists and general practitioners (GP). MethodsA mixed-methods study was conducted using routine care data from electronic health records (EHR) and semi-structured interviews. Referrals to 15 departments between August 2019 and July 2021 were included, with a six-month follow-up period. Referrals were assessed regarding the expected added value of secondary outpatient consultation and correctly chosen specialty. To gain insight into professionals experiences, interviews were conducted with GPs and with medical specialists from each participating department. ResultsA total of 109,953 primary care referrals were registered by participating departments. Of these, 4.262 (3.9%) were directed back to primary care, with redirection varying across departments (0% to 17.1%). Of the redirected referrals with six-months of follow-up, 274 of 3461 patients (7.9%) were re-referred for the same care need within this period. Qualitative findings showed overall positive experiences among medical specialists, with major time investment as the most important barrier to triage. GPs expressed more mixed feelings, with reported barriers including a sense of undermining of autonomy and lack of collaboration, although guidance and advice from specialists was much appreciated. ConclusionThis study showed that a hospital-wide triage strategy can be effective in reducing outpatient consultations, with redirected referrals supported by advice and/or treatment guidance for the referring GP. Qualitative insights suggested that safeguarding mutual respect and cooperation between specialists and GPs needs to be addressed during the implementation of a triage system.