Assessing the Quality of the Saudi Healthcare Referral System: Potential Improvements Implemented by Other Systems

INTRODUCTION: The referral system authorizes and transfers the responsibility for healthcare services from one provider to another. A key component of the system is the communication between primary-care and specialist providers. Poor communication between them is detrimental to and can cause significant issues with coordination of effective care.

OBJECTIVE: The purpose of this review was to evaluate current healthcare referral systems, focusing on the communication among providers, and to suggest practices that could make the Saudi healthcare referral system more effective.

DESIGN: This systematic review identified published studies of the quality of the healthcare referral system in Saudi Arabia and other countries using two databases, Medline and PubMed. Data were summarized and extracted into two tables.

RESULTS: The review included 12 studies that met its selection criteria. These studies were conducted in various regions of Saudi Arabia, but mostly the west and north. The 12 studies included 181,192 participants, with numbers of participants ranging from 21 to 138,484. The present review found that more than 50% of the referral documents and feedback reports in these studies had incomplete patient information. Implementation of electronic referrals (e-referrals) in several countries, including Australia, New Zealand and the United States, improved their referral systems, particularly by solving the problem of incomplete referral documents. In addition, the present review found that in some specialist clinics, referral cases contributed to increased workloads. One study reported on implementation of Lean Six Sigma principles in a military hospital in western Saudi Arabia, which reduced the number of referrals delayed, inappropriate referrals and the response time to referrals (7%). E-referrals and Lean Six Sigma principles may be applicable in Saudi Arabia as solutions to referral and response-time problems.

CONCLUSIONS: An increase in healthcare referrals in Saudi Arabia has caused an increase in missing essential information in referral letters and feedback reports as well as overcrowding in specialist clinics. The results of the present review suggested that implementing e-referral and Lean Six Sigma principles may improve the quality of Saudi Arabia’s healthcare referral system.