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Referral Assessment Services - NHS e-Referral Service
This page details functionality which provides the ability to triage referrals before booking an appointment for patients using the NHS e-Referral Service (e-RS). This supports complex clinical pathways and helps to reduce demand to elective care services.
Referral Assessment Services (RAS) allow providers to:
- assess the Clinical Referral Information from the GP/referrer without the need for an appointment being booked
- decide on the most appropriate onward clinical pathway
- contact the patient to discuss choice (if an elective referral)
- arrange an appointment, where needed
- return the triage request to the original referrer with advice, if an onward referral isn't need
This facility supports complex care pathways, such as gastroenterology and cardiology, where it's not always clear whether a patient needs a consultant appointment or a diagnostic test. A RAS set up by the provider will ensure patients' referrals are triaged correctly.
Information for service definers
Service definers can set up RAS services using the service definition screen in e-RS.
To do this:
- Select the Add New Service button.
- Under the Request Types Supported section select Triage Request.
Note: that a RAS service can be set up to offer advice and guidance as well but cannot be set up to offer appointments.
- There are no booking requirements for setting up a RAS service as there are no appointments available.
An error message will appear when converting a pre-existing service if it allowed appointment booking
- Continue to set up the service as you would for any other e-RS service definition.
Find out more about setting up services in e-RS.
Information for referrers
Referrers can send their patient referrals directly into a RAS without having to book an appointment for the patient.
When a service search is being initiated, a RAS service will have a Send for Triage button instead of the usual tick box option on the service selection screen.
Note: a RAS cannot be added to a shortlist of services when creating a request for the patient, it must be the only option selected.
Once the request has been created, the clinical referral information will need to be attached to the referral before the service provider is able to complete a triage.
Referrers can provide patients with a letter, detailing the service that they have been referred to and what to expect next. An example is shown below:
Find out more about creating referrals.
Managing RAS responses
RAS referrals can be returned, in the event that the service provider feels that this is necessary. This may be because the referral needs to be redirected to another service, the provider clinician may need more information, or the patient may be suitable for treatment in primary care.
Returned referrals will appear on the Referrer Action Required worklist with a referral status of Triage Response.
Referrers have several actions that they can complete on this referral:
End Triage Request will complete the referral and remove it from all worklists, effectively closing the referral.
Modify Referral Letter gives you the option to change or add further clinical referral information.
Update/Book allows the referrer to change the referral to a new service.
Information for service providers
Service provider clinicians can review referrals sent to their service using the Referrals for Review worklist. The Referrals for Review worklist can show different types of referrals depending on the filters used. This can be filtered to see only RAS referrals when the referral type is filtered by clicking on the triage button.
Below are loaded results showing all referral types. This is where the filter button (Show All) under the Referral Type has been applied. This can be identified using the Appointment column.
Below are loaded results showing only RAS referrals, where the filter button (Triage) under the Referral Type has been applied. This can be identified using the Appointment column.
Selecting a UBRN will open the referral summary page. From here, the referral should be reviewed and a triage outcome recorded by clicking on the Record Triage Outcome button.
Service provider clinicians can then record the triage assessment by selecting the appropriate outcome and adding comments plus attachments if needed.
Service provider clinicians have three different triage outcomes to select:
Refer/Book Now - allows the service provider clinician to shortlist the appropriate service and make a request. The clinician, before making the request, can also book an appointment for the patient if he/she wishes to perform that task. When the option of Triage Outcome is used the referral will be removed from the Referral for Review list and will appear on the Appointment for Booking worklist if the appointment is yet to be booked. If the appointment has been booked, then you will be able to find this referral on is the Outbound Referral worklist.
Accept and Refer/Book Later - allows the service provider clinician to change priority of the request and add an attachment if needed. There is also a mandatory comment box which allows the clinician to add onward instructions to allow later processing of the request. When this option of Triage Outcome is used the referral will be removed from the Referral for Review list and will appear on the Appointment for Booking worklist.
Return to Referrer with Advice - allows the service provider clinician to return the triage request with advice if an onward referral is not needed. When this triage outcome is selected the request will be removed from the provider worklists.
NOTE: If a triage request is booked into an appointment, and the provider subsequently rejects the referral, this will return the referral onto the GPs Referrer Action Required worklist and not the Outbound Referrals worklist for the triage service.
Appointment for booking worklist
Triaged referrals that require an appointment to be booked will appear on the Appointment for Booking worklist.
The Reason column will display the following statuses:
- ‘Triaged – see comments’ – when a clinician has reviewed the referral and added comments/instructions for the administrative staff regarding the booking.
- ‘Triaged – To be booked’ - when a clinician has reviewed the referral and has shortlisted appropriate service/s for the patient with comments/instructions for the administrative staff.
Note: service provider administrators are unable to change the selected service.
To perform an action on a referral, select the required UBRN. Information is displayed which includes the Triage Outcome and Triage Comments. From here the Actions drop down can be selected the appropriate option chosen.
End Triage Request will complete the referral and move it from all the providers worklist.
Update/Book allows the provider to change/maintain the service and send request or book an appointment for the patient.
View History allows the provider to view the referral history including the triage outcome and comments.
View Request displays the request details and provides options to add clinical information or additional requirements
Supporting information on RAS's can be found in the e-RS help (N3/HSCN connection required).