• Oliver Kennion, Nithish Jayakumar, Muhammad Ahmad Kamal, Melissa Gough, Menaka Paranathala, and Patrick Mitchell.
• Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom. Electronic address: o.kennion@nhs.net.
• World Neurosurg. 2022 Sep 1; 165: e438e445e438-e445.

ObjectiveWe sought to review the current scope of emergency neurosurgical referrals and examine the long-term use of a web-based referral system.MethodsThis was a single-center retrospective observational study. Referral information was collected retrospectively over a 1-year period after the implementation of a web-based referral system (June 2019-June 2020). Information such as demographics, clinical information, referrer details, and neurosurgical response times and outcomes were collected. Statistical analyses were performed using R Version 6.3.1.ResultsOur unit received 5949 referrals with a median age of 63 years old (range: 0-107 years) (male = 50.3%). We observed an average of 16.3 referrals per day (range: 4-32), with Fridays having the highest average and the weekend days receiving statistically fewer referrals (P < 0.001). More than a third (35.9%) of referrals occurred within hours (8:00-17:00 Monday-Friday), with A + E making up approximately 50% of referrals. Common reasons for referral were traumatic brain injury, intracranial tumors, and degenerative spine. The median time from referral to first response was 32 minutes, occurring within an hour in 72.9% of cases. The median time to definite response was 83 minutes, occurring within 2 hours in 58.2% of cases. Factors found to impact the response time were referral emergency and time of day. Our acceptance rate over this period was 18.5%.ConclusionsWith an increasing number of referrals, it is feasible to provide traceable advice in a timely manner through an electronic web-based referral system transferable to any specialty. Insights could be used to direct resources and workforce planning according to emergency referral patterns.Crown Copyright © 2022. Published by Elsevier Inc. All rights reserved.

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