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Email triage is an effective, efficient and safe way of managing new referrals to a neurologist
  1. Victor Patterson1,
  2. Jenny Humphreys2,
  3. Mark Henderson1,
  4. Grainne Crealey3
  1. 1Department of Neurology, Royal Victoria Hospital, Belfast, UK
  2. 2Visiting Consultants' Team, Erne Hospital, Enniskillen, UK
  3. 3Senior Health Economist, Clinical Research Support Centre, Royal Victoria Hospital, Belfast, UK
  1. Correspondence to Professor Victor Patterson, 58 Lisnabreeny Road East, Belfast BT6 9SS, UK; vhp498{at}


Background Patients referred to secondary care in the UK often wait many months to be seen, and the UK government has announced various initiatives to address this issue. Since 2002, we have developed an email referral system which allows some neurological referrals to be managed by advice and investigations rather than by a conventional hospital clinic appointment. This system has previously been shown to reduce clinic attendances and to be acceptable to patients and their general practitioners (GPs).

Aim To analyse the effects of an email triage system on waiting times, cost of care and safety over 5 years.

Methods Referral numbers and waiting times for clinics using this system were analysed. Cost was determined by comparing detailed costs with those of conventional care. Safety was analysed by examining the GP records of all patients referred from a single practice who had been dealt with by advice or investigation, noting deaths, re-referrals and changes in diagnosis.

Results Waiting times fell from 72 to 4 weeks, despite an increase in referrals. The cost per patient of email referral was about £100, compared with £152 for conventional care, a 35% reduction. Safety data on 120 individuals showed a minor change in diagnosis in three.

Discussion This system is safe, effective (in reducing waiting times) and efficient. It enables neurologists to focus on patients with significant neurological disease and, if applied more widely, could reduce costs and waiting times for neurology services in the UK.

  • Neurology
  • telemedicine
  • teleneurology
  • health services research
  • ambulatory care
  • quality of healthcare
  • decision making
  • healthcare quality improvement
  • information technology
  • patient-centred

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  • Competing interests VP is founder and Chairman of Synapse Teleneurology Ltd.

  • Provenance and peer review Not commissioned; externally peer reviewed.