Experience of Bi-directional Referral Project between National Taiwan University Hospital Medical Center and Taipei City Hospital, Zhongxiao Campus Community Hospital

Abstract Background Overcrowding in medical center's emergency departments may threaten quality and safety of health services. The aim of our study is to retrospectively evaluate the practice of bi-directional referral project between National Taiwan University Hospital (NTUH) medical center and Taipei City Hospital Zhongxiao Branch community hospital. Methods We retrospectively collected data from 38 electric and paper records of nineteen age- and gender-matched concurrent control patients without bi-directional referral and nineteen case patients who received bi-directional referral between NTUH Medical Center and Zhongxiao Community Hospital from January 1st, 2017 to November 30th, 2017. Patients admitted not due to bidirectional referral during the same period were used as a control group. Mortality rate, rate of transfer back to National Taiwan University Hospital, 11-point satisfaction rating scale are used as key performance indexes of quality improvement of clinical services. Satisfaction of the enrolled patients was evaluated with the questionnaires containing satisfaction rating scale 0-10. An independent samples t test was used to compare the means of variables between the ESI triage level 2 and ESI triage level 3 groups. Results The ESI (emergency severity index) triage level 2 patients were significantly older than the ESI triage level 3 patients with non-significant p value of Levene's test indicating equal variance between the control and case groups, but there was no significant difference of average total satisfaction (TSAT) score of bidirectional referrals between these two ESI groups. Mortality rate is zero. Rate of transfer back to NTUH is zero. The average TSAT score of case group is 8.89± 0.81 while the average TSAT score of the control group is 9.40± 0.31.Both the average TSAT scores of the case and control groups were above 8. Conclusion Early orienting of the admission of elderly patients on bi- directional referral system was demonstrated in this study. The parameters of quality of health care of the case group are comparable to those of the control group. The 0% mortality rate, 0% rate of transfer back to NTUH and good average TSAT score suggest that the referral program is safe and the quality of clinical services of these bi-directional referral patients is good.