Background
Clinical Neurophysiology at the Queen Elizabeth University Hospital (QEUH) in Glasgow provides on-call services (using a shared on-call email address) to the West of Scotland (Greater Glasgow & Clyde, Lanarkshire, Ayrshire & Arran, Golden Jubilee National Hospital). Information from referrals can be variable or missing. This leads to multiple email exchanges, which is time consuming and can delay patient investigations and treatment. Therefore, our aim was to gain an objective understanding of the quality of information received from the on-call email referrals to Clinical Neurophysiology.

Methods
We collected data from all referrals to the Clinical Neurophysiology on-call email inbox (ggc.neurophysoncall@nhs.scot) for a 6 week period between Monday 18th September to Friday 27th October 2023. Weekend referrals were not included as these are done via telephone call to the on-call consultant.

Results
Requests for inpatient investigations made up 95% of all referrals, with over 2/3rd for electroencephalography (EEG), compared with 1/3rd for nerve conduction studies (NCS) and/or electromyography (EMG). Referrals were received from numerous different specialties, hospitals and grades with critical care/neurology, QEUH and registrars/SHOs being the most common, respectively. Over 90% of referrals included a patient name and Community Health Index (CHI) number but 18% did not include the hospital. Around 50% did not include the patient’s medical background or examination findings. Almost 90% of referrals were accepted with moderate variability between specialty and grade of referrer. The mean number of emails per referral was 2.1 (excluding the initial referral email). The median time from ‘referral-to-test’ was 2.5 hours for EEG and 46.3 hours for NCS/EMG.

Conclusion
The quality of information in email referrals is highly variable. Despite these difficulties, the service provided by Clinical Neurophysiology is timely and efficient. Robust auditing of email referrals is challenging and those that used a standardised proforma were the most helpful. Re-auditing this data in the future will be useful to monitor the service over time, with consideration given to possible alternative referral systems. These may include standardised proforma usage on the intranet, automated email replies, Trakcare (local electronic patient record system) or Scottish Care Information (SCI) referrals.