Electronic Outpatient Referral System for Liver Transplant Improves Appropriateness and Allows First Visit Triage

Missed or inappropriate referrals of potential candidates for liver transplantation (LT) are common and traditional referral methods (tRs) do not allow for efficient triage. We investigated the effects of a website developed for electronic outpatient referral to LT (eRW-LT) on these issues. We prospectively collected data on all consecutive outpatient referrals to 2 Italian LT centers from January 2015 to December 2019. In the second half of the study, starting from July 2017, referring physicians had the option of using eRW-LT, quickly obtaining the judgment on the appropriateness and urgency of the visit from a transplant hepatologist. In the second half of the study, there were 99 eRW-LTs and 96 traditional referrals (new tRs), representing a 17.4% increase over the 161 traditional referrals (old tRs) of the first half. With eRW-LT, 11.1% of referrals were judged inappropriate online without booking a visit. Appropriateness, judged at the time of the first visit, was 59.6%, 56.2%, and 94.3% with old tRs, new tRs, and eRW-LT, respectively. Considering the appropriate visits, the median waiting time in days between referral date and first visit appointment was significantly shorter for urgent visits referred with eRW-LT (5.0; 95% CI, 4.8–9.3) compared with nonurgent visits sent with the same system (17.0; 95% CI, 11.5–25.0; P < .0001), those referred with old tRs (14.0; 95% CI, 8.0–23.0; P < .001) and with new tRs (16.0; 95% CI, 10.0–23.0; P < .001). eRW-LT allows an increase in the number of referrals for LT, ensuring effective triage and better appropriateness of visits.