EP 548 From Guesswork to Guidance: A Flowchart for Taking Referrals in Emergency General Surgery

Abstract

Emergency General Surgery (EGS) referrals are a critical entry point to patient care. Senior house officers are expected to take these referrals, and often make rapid triage decisions without consistent guidance. Inconsistent clinical and policy guidance at this early stage can compromise patient safety, increase inappropriate referrals, and reduce resident doctors’ confidence. This project, via the introduction of structured referral flowcharts, sought to improve the confidence of SHOs and more importantly- patient safety.

A baseline questionnaire was designed and distributed to SHOs working in the EGS assessment unit. It explored awareness of local referral policies, accuracy in case-based referral scenarios, and self-reported confidence in managing referrals on a ten-point Likert scale. In response to identified gaps, a referral flowchart was developed outlining common presentations, the appropriate receiving specialty, and key investigations to consider prior to deciding. This was introduced through targeted teaching and booklets were prominently distributed within the unit. The same questionnaire was subsequently repeated to evaluate the intervention.

Preliminary findings show significant improvement in knowledge of referral policies, greater consistency in case-based decision-making, and an increase in reported confidence scores. Respondents described the flowchart as reducing uncertainty, supporting safer triage, and providing a valuable framework for discussion with seniors.

In conclusion, simple, structured flowcharts improved the quality of EGS referrals and enhanced SHO confidence in a high-pressure setting. This low-cost intervention is easily reproducible, generalisable to other units, and offers a practical means of reducing cognitive load on junior staff while supporting safe patient care.