Ellen Wright, York Hagmayer and Irene Grayson

An evidence-based referral management system: Insights from a pilot study

Primary Health Care Research and Development

Objectives: Improving the informational quality of referrals from primary to secondary care and appropriately re-directing referrals is an important goal of clinical commissioning groups in England. Based on the available empirical evidence, a referral management and booking service that combined referral guidelines, online referral templates and administrative and clinical triage, was developed by a primary care trust in southeast London. Methods: A pilot study of 13 out of 46 practices in the trust was conducted using a mixed methods approach. Referral numbers were investigated by analysing changes in practicesʼ rates of first outpatient attendances in secondary care. Informational referral quality was assessed by analysing triage outcomes. Semi-structured interviews were used to inquire about practicesʼ evaluation of the new system. Structured telephone interviews were conducted to assess patientsʼ satisfaction. Results: Overall rates of first outpatient attendances declined more strongly for pilot practices than controls. The number of referrals challenged for being incomplete or having insufficient clinical information decreased. The rate of referrals challenged by clinical triage for not conforming to referral guidelines was well below the rate of inappropriate referrals published in the literature. Interviews with practices revealed a number of themes and a broad range of attitudes. Patients were highly satisfied. Discussion: Findings provided favourable evidence for the effectiveness of the new referral management system. They were, however, preliminary. If referrals into secondary care continued to be reduced on a long-term basis, the system would be cost effective despite the time and effort required for clinical triage. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Accession Number: 2015-27934-008. PMID: 25323948 Partial author list: First Author & Affiliation: Wright, Ellen; Department of Primary Care and Public Health Sciences, Kingʼs College London, London, United Kingdom. Other Publishers: Hodder Arnold. Release Date: 20150720. Publication Type: Journal (0100), Peer Reviewed Journal (0110). Format Covered: Electronic. Document Type: Journal Article. Language: English. Major Descriptor: Health Care Services; Professional Referral. Classification: Health & Mental Health Services (3370). Population: Human (10); Outpatient (60). Methodology: Empirical Study; Interview; Qualitative Study; Quantitative Study. References Available: Y. Page Count: 8. Issue Publication Date: Jul, 2015. Publication History: First Submitted Date: Nov 14, 2014. Copyright Statement: Cambridge University Press. 2014.