HowToRefer

HowToRefer is a searchable directory for hospital referral pathways. It gives clinicians one place to find the local process, eligibility criteria, required information, and contact route for referring a patient to a specialty, service, or multidisciplinary team.

I identified the problem while working as an FY1 doctor at Queen Elizabeth Hospital. Hospital WhatsApp groups repeatedly filled with questions such as “How do I refer to cardiology?” or “Does this MDT need a form or an email?” Those messages were not isolated knowledge gaps; they were evidence that the referral system itself was difficult to navigate.

Referral knowledge was fragmented across systems and changed by service. Most inpatient referrals used iCare; cardiology and gastroenterology required paper forms; many MDTs used email; and surgical teams were commonly reached by bleep or phone. Conditions and required information also varied from one receiving team to another.

This was hardest for new starters and rotating doctors. Every move to a new hospital or department reset their local knowledge, even though making referrals was a routine part of patient care.

I turned the repeated WhatsApp questions into a quality-improvement project and surveyed 16 junior doctors. The results confirmed that the problem was systemic: 87.5% found pathways through word of mouth or WhatsApp, 56.3% described finding the correct route as challenging or very challenging, and only 12.5% found it easy.

Three quarters had experienced at least one failed referral, while 81.3% said finding a pathway was slower than finding a bleep or phone number. The comparison suggested a useful model: clinicians already used a simple directory for hospital numbers, so referral instructions should be just as searchable.

I designed HowToRefer around the question a doctor has at the point of care: for this patient, at this hospital, how do I make the referral correctly? Search starts with a specialty, condition, hospital, or keyword and brings the actionable details forward—the acceptance criteria, required information, method, and destination.

The React interface is backed by a Laravel model for hospitals, pathways, specialties, referral criteria, and contact routes. The experience is deliberately mobile-friendly because lookup often happens on a ward, between clinical tasks, rather than at a desk.

A directory is only clinically useful if users trust that it reflects current local practice. A single national template would be easier to scale, but it would flatten the differences that caused the problem in the first place.

HowToRefer keeps pathways hospital-specific and gives local members a route to propose additions or changes, with administrators responsible for review and publication. That balances distributed knowledge with clear ownership, while keeping previous guidance from becoming an unmoderated wiki.

HowToRefer grew from a local FY1 quality-improvement project into a live clinical product adopted across three NHS hospitals. The product converts knowledge that previously disappeared into chats and word of mouth into a shared, maintainable operating resource for each hospital.