Hospital referral rates in England have increased significantly over recent years, resulting in the management of referrals becoming a high priority for many local health communities as a means of controlling their capacity and budgets. In 2010 The King's Fund issued a report ‘Referral Management - Lessons for success’ which lists ways in which clinical commissioners might ensure referral management strategies improve quality and make savings.
In the King's Fund report:
"there was evidence that full-scale referral management centre are unlikely to present value for money and some of the new clinical triage and assessment services might add to rather than reduce costs"
"instead, a referral management strategy built around peer review and audit, supported by consultant feedback, with clear referral criteria and evidence-based guidelines is mostly likely to be both cost and clinically effective"
Find out more about the King's Fund report.
The role of e-RS in the stages of referral management
e-RS can support all the six stages of referral management listed above.
Stage 1: Professional knowledge
- it is the responsibility of commissioning organisations to ensure that adequate service provision is made for the clinical needs of patients and that community services exist which deliver cost and clinically effective alternatives to hospital-based services
- these services should be made available on e-RS to provide referrers with an easy way of identifying what is available locally
- it is the responsibility of referring clinicians to ensure that they are up to date with available treatment options and that they know the conditions that are best dealt within differing care settings
Clinicians should use e-RS to:
- see what services are available in the community
- monitor outcomes of referrals
- note responses from advice and guidance requests
- note and act on rejection advice
- update knowledge based on advice in service details or links to external guidance
Stage 2: External resources
e-RS allows links to external guidance via hyperlinks. For example:
- national guidance (for example NICE)
- map of medicine
- local hospital protocols
- local and national referral forms (that check referral criteria have been met)
e-RS contains several search methods (for example using clinical terms) to find appropriate services and identify referral criteria.
Stage 3: Peer review
- peer review should ideally take place within the referring organisation by clinicians meeting regularly to discuss individual cases
- smaller practices should consider sharing/pooling skills and resources to assess referrals
- advice and guidance can be used to allow referral assessment by clinicians in the same or local organisations
Stage 4: Advice and guidance
- e-RS supports the concept of one clinician asking for advice from another and receiving a reply
- advice and guidance should be used where genuine questions need to be asked regarding referral options or where complex, alternative treatment pathways exist
- referrers should see this as a tool to improve their knowledge base and avoid the need to seek advice for similar conditions in the future
Stage 5: Clinical assessment services
- should be aimed at determining the correct clinical pathway for the patient, where the referrer is unsure or where the options are complex
- should provide added clinical value to the referral pathway
- should minimise lengthening of referral to treatment times and be provided for specialties where proven benefits are likely
- must be carried out by clinicians who are authorised and suitably skilled to be able to deviate from agreed protocols, based on individual patient needs, if required
- should, wherever possible, involve a personal interaction between the provider clinician and the patient or their referring clinician
- should take place at a pre-arranged time that the patient is aware of
- should address the concerns and uncertainties of patients
Stage 6: Rejection of referrals
- provider clinicians (for example consultants/AHPs) must be empowered to reject clinically inappropriate referrals but must be mindful of the effect of rejection on patients and the reputation of fellow professionals
- provider clinicians should feed-back (via commissioning groups) the details of referrers who are consistently referring inappropriately
- re-direction should be considered as an alternative to rejection where the referral is appropriate, but where a more suitable clinic/service exists
- referring clinicians should accept feedback and referral outcomes as a positive learning experience
- effects on patients should always be considered (for example it must be in a patient’s best interests to reject)
Last edited: 27 January 2020 3:30 pm