08 November 2022
Consultant-led triage of all referrals helps ensure that we’re making the best use of new patient appointments.
As well as having a consultant check all referrals ‘at the front door’, the team at Lancashire and South Cumbria NHS Foundation Trust also offers specialist advice straight to primary care.
Here, Dr. Lizzy MacPhie explains how this is benefitting the National Early Inflammatory Arthritis Audit.
Reviewing referrals
We have a consultant review all referrals that come into the service. This allows us to challenge those where we’re lacking the information we need. We can redirect referrals that are more appropriate to be seen by another discipline within our integrated MSK service.
Where appropriate, it ensures we can respond with an immediate specialist opinion, rather than the patient having to wait weeks to be seen. It means that we prioritise appointments for those who need to be seen in a specialist rheumatology clinic.
Advice and Guidance (A&G)
In December 2020, a new A&G platform was launched in our area. Initially, if there was a referral identified at triage that we thought would be suited to A&G, we would reply to primary care and ask them to resend it via that channel. But we soon realised it was creating more work both for ourselves and primary care.
We decided that as the consultant was making the triage decision, we could respond immediately to requests with a specialist opinion. We considered the option of pushing every referral through A&G but recognised the additional administrative work for primary care if a query then needed to be converted into a referral.
Supporting the national audit
What it’s meant for the NEIAA is that we’re getting better quality referrals through. We’ve reduced our routine waits from 16 weeks to 12 weeks, and our urgent appointments are between two and three weeks.
When we look at our NEIAA data and those triaged to an EIA appointment over a 6-month period, 51% of patients in 2022 compared to 37% of patients in 2019 have been subsequently diagnosed with EIA, demonstrating we are seeing more appropriate patients in our urgent appointments.
Working with primary care
We’ve produced guidance for primary care as to what’s appropriate for A&G and updated our directory of services in line with the BSR referral guidance published last year.
In partnership with primary care, we agreed to a letter that goes to the patient explaining that we don’t need to see them in the clinic and that their GP has been provided with immediate advice and will be in touch.
Spotting trends
We’ve got six months of robust triage data which has helped us to identify trends. We send back more referrals when they’ve come from nurse practitioners and first contact practitioners, most often for more information.
We’ve identified high-referring practices and those where we are returning or redirecting more referrals. Collecting this data means we can target education.
Advice to other units
- Stakeholder engagement is important. Make sure you engage with primary care to identify any unintended consequences early.
- Review and align your directory of services to the new BSR referral guidance and give primary care colleagues information to help them use the referral and A&G systems better.
- Standardise responses for triage and A&G so you can provide consistent responses.
- Collect triage data to demonstrate appointments saved and to inform discussions about job planning the workload.
- Ensure you plan the time for clinical triage and responding to A&G queries.