Abstract
BackgroundReferral management centres (RMC) for elective referrals are designed to facilitate the primary to secondary care referral path, by improving quality of referrals and easing pressures on finite secondary care services, without inadvertently compromising patient care.This study aimed to evaluate whether the introduction of a RMC which includes triage and feedback improved the quality of elective outpatient referral letters.MethodsRetrospective, time-series, cross-sectional review involving 47 general practices in one primary care trust (PCT) in South-East England. Comparison of a random sample of referral letters at baseline (n = 301) and after seven months of referral management (n = 280). Letters were assessed for inclusion of four core pieces of information which are used locally to monitor referral quality (blood pressure, body mass index, past medical history, medication history) and against research-based quality criteria for referral letters (provision of clinical information and clarity of reason for referral).ResultsFollowing introduction of the RMC, the proportion of letters containing each of the core items increased compared to baseline. Statistically significant increases in the recording of ‘past medical history’ (from 71% to 84%, p < 0.001) and ‘medication history’ (78% to 87%, p = 0.006) were observed. Forty four percent of letters met the research-based quality criteria at baseline but there was no significant change in quality of referral letters judged on these criteria across the two time periods.ConclusionIntroduction of RMC has improved the inclusion of past medical history and medication history in referral letters, but not other measures of quality. In approximately half of letters there remains room for further improvement.
Highlights
Referral management centres (RMC) for elective referrals are designed to facilitate the primary to secondary care referral path, by improving quality of referrals and easing pressures on finite secondary care services, without inadvertently compromising patient care
We studied a RMC established in 2008 for 47 practices (134 whole time equivalent General practitioner (GP)) within one primary care trust (PCT)
The majority of referral letters (time 0: 196 (65.1%) and time 1: 190 (67.9%)) were in the format of a letter plus selected data downloaded from electronic patient records (Table 1)
Summary
Referral management centres (RMC) for elective referrals are designed to facilitate the primary to secondary care referral path, by improving quality of referrals and easing pressures on finite secondary care services, without inadvertently compromising patient care. This study aimed to evaluate whether the introduction of a RMC which includes triage and feedback improved the quality of elective outpatient referral letters. GPs write more than 10 million elective referral letters each year for routine management of conditions [1]. Used passively and in isolation, guidelines and proformas have not always succeeded in improving the content of referral letters [7,8]. Multi-faceted interventions such as peer or specialist feedback together with guidelines, proformas or risk factor check-lists have been shown to improve the referral process, including improved letter content [6,9,10,11,12,13,14,15,16,17]. A Cochrane review of educational, organisational and financial interventions to improve out-patient referral rates and appropriateness has noted that simple interventions and passive dissemination are ineffective in changing clinicians’ behaviour [18]
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