Orthodontic referral management systems: Do they make a difference?

Abstract

Aims: To assess the performance of the referral management system (RMS) compared to a previous paper-based referral system and to determine whether referrals reflected the patients’ malocclusion and met current guidelines. Design: Three-cycle audit. Setting: Orthodontic Department, Liverpool University Dental Hospital, UK. Participants: Consecutive new orthodontic patient referrals. Methods: Data were collected prospectively from orthodontic referral letters and new patient clinic proformas (2016–2017). Cycle 1 assessed the original paper-based referral form, Cycle 2 assessed the first RMS online form and Cycle 3 assessed a modified RMS form. Results: Cycles 1, 2 and 3 audited 83, 84 and 81 referrals, respectively. Agreement between the reason for referral and the new patient clinic findings was moderate for Cycles 1 and 3 (Kappa = 0.47 and 0.60, respectively) and fair for Cycle 2 (Kappa = 0.40). In Cycles 1, 2 and 3, the proportion of new patients appropriate for hospital orthodontic care reduced from 52% to 51% and 40%, respectively. None of the three cycles reached the 90% target for compliance with current referral guidelines. Conclusions: Cycle 3’s RMS form gave a truer reflection of the patients’ malocclusion but reduced the proportion of appropriate referrals. Further audit is required in this area to investigate the cost-effectiveness and clinical benefits of the RMS.