Orthodontic referral management systems: Do they make a difference?

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.