Prioritisation of vascular outpatient appointments cannot be based on referral letters alone

Patel, Niravkumar; D'souza, Janita R. T.; Rocker, Michael; Townsend, Elaine; Morris‐Stiff, Gareth; Manimaran, M.; Magee, T.R.; Galland, R. B.; Lewis, MH

doi:10.1016/s1479-666x(08)80108-4

Cited by 10 publications

(8 citation statements)

References 2 publications

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“…Previous studies highlight that missing information can have effects on risk assessment, patient triage, and resource allocation. 12,13 In our data set, many referrals were re-graded during the triage process. This regrading, with its disruption to the pathway, would almost certainly be reduced by the provision of clearer information.…”

Section: Discussion and Resultsmentioning

confidence: 99%

Improving the referral process from primary care to an AMHT

Dehghan¹,

Nowar²,

Molodynski³

2017

Prog Neurol Psychiatry

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Section: Discussion and Resultsmentioning

confidence: 99%

Improving the referral process from primary care to an AMHT

Dehghan¹,

Nowar²,

Molodynski³

2017

Prog Neurol Psychiatry

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“…A recent Canadian survey of more than 3000 GPs and specialists found that, among the main problems specialists identified, 51 % of referral letters had an unclear reason for referral [ 13 ]. This variation in quality makes the evaluation and prioritisation of incoming referrals difficult, with one author stating that prioritisation cannot be performed based on referral letters alone [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of referral templates on the quality of referrals from primary to secondary care: a cluster randomised trial

Wåhlberg

Valle

Malm

et al. 2015

BMC Health Serv Res

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BackgroundThe referral letter is an important document facilitating the transfer of care from a general practitioner (GP) to secondary care. Hospital doctors have often criticised the quality and content of referral letters, and the effectiveness of improvement efforts remains uncertain.MethodsA cluster randomised trial was conducted using referral templates for patients in four diagnostic groups: dyspepsia, suspected colorectal cancer, chest pain and chronic obstructive pulmonary disease. The GP surgery was the unit of randomisation. Of the 14 surgeries served by the University Hospital of North Norway Harstad, seven were randomised to the intervention group. Intervention GPs used referral templates soliciting core clinical information when initiating a new referral in one of the four clinical areas. Intermittent surgery visits by study personnel were also carried out. A total of 500 patients were included, with 281 in the intervention and 219 in the control arm. Referral quality scoring was performed by three blinded raters. Data were analysed using multi-level regression modelling. All analyses were conducted on intention-to-treat basis.ResultsIn the final multilevel model, referrals in the intervention group scored 18 % higher (95 % CI (11 %, 25 %), p < 0.001) on the referral quality score than the control group. The model also showed that board certified GPs and GPs in larger surgeries produced referrals of significantly higher quality.ConclusionIn this study, the dissemination of referral templates coupled with intermittent surgery visits produced higher quality referrals.Trial registrationThis trial has been registered at ClinicalTrials.gov. The trial registration number is NCT01470963.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1017-7) contains supplementary material, which is available to authorized users.

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“…3 In allergy services, application of agreed referral criteria led to rejection of 48% of referrals. 4 Thirty-seven per cent of non-urgent cancer referrals were assessed as being unnecessary according to published guidelines, 5 while 27% of orthopaedic referrals would have been more appropriate for rheumatology. 6 There is also evidence suggesting that, in certain specialties, some patients are not referred until their condition has reached an advanced stage.…”

Section: Introductionmentioning

confidence: 99%

Do referral-management schemes reduce hospital outpatient attendances? Time-series evaluation of primary care referral management

Cox

Steel

Clark³

et al. 2013

Br J Gen Pract

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BackgroundNinety-one per cent of primary care trusts were using some form of referral management in 2009, although evidence for its effectiveness is limited. AimTo assess the impact of three referralmanagement centres (RMCs) and two internal peer-review approaches to referral management on hospital outpatient attendance rates. Design and settingA retrospective time-series analysis of 376 000 outpatient attendances over 3 years from 85 practices divided into five groups, with 714 000 registered patients in one English primary care trust. MethodThe age-standardised GP-referred first outpatient monthly attendance rate was calculated for each group from April 2009 to March 2012. This was divided by the equivalent monthly England rate, to derive a rate ratio. Linear regression tested for association between the introduction of referral management and change in the outpatient attendance rate and rate ratio. Annual group budgets for referral management were obtained. ResultsReferral management was not associated with a reduction in the outpatient attendance rate in any group. There was a statistically significant increase in attendance rate in one group (a RMC), which had an increase of 1.05 attendances per 1000 persons per month (95% confidence interval = 0.46 to 1.64; attendance rate ratio increase of 0.07) after adjustment for autocorrelation. Mean annual budgets ranged from £0.55 to £6.23 per registered patient in 2011/2012. RMCs were more expensive (mean annual budget £5.18 per registered patient) than internal peer-review approaches (mean annual budget £0.97 per registered patient). ConclusionReferral-management schemes did not reduce outpatient attendance rates. RMCs were more expensive than internal peer review.

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Prioritisation of vascular outpatient appointments cannot be based on referral letters alone

Cited by 10 publications

References 2 publications

Improving the referral process from primary care to an AMHT

Improving the referral process from primary care to an AMHT

Impact of referral templates on the quality of referrals from primary to secondary care: a cluster randomised trial

Do referral-management schemes reduce hospital outpatient attendances? Time-series evaluation of primary care referral management

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