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INTEGRATION OF REFERRAL INFORMATION AND
PATIENT FLOWS:
THE ROLE OF REFERRAL MANAGEMENT
IN TAYSIDE
Linda Fox/Rebecca Locke
A History Lesson
•
Implementation of locally developed system Electronic Referral Service
(ERS) for electronic referrals to all provider units across Tayside
excluding Community Services
– Live within 7 pilot practices in May 2001
•
Receipt by Medical Record Departments across Tayside & printed off
•
SIGN guideline compatibility for all specialties
•
5 protocol referrals were developed:
• General psychiatry (for 1 CMHT)
• General Surgery – Breast clinic
• Menorrhagia
• Pain Clinic
• Vascular Surgery – carotid endarerectomy
Moving on to a Referral
Management System
•
June 2005 - Dermatology participated in a pilot enabling
clinicians to electronically screen referrals.
•
Clinicians screen referrals at source with the following options:
• Booking clinic requests
• Cancelling referrals
• Redirecting referrals to other specialties/locations
•
Messages are sent electronically back to the GP practice via
ERS indicating any updates.
Impact of ERS/RMS within NHS Tayside
•
Reduction in the Patient’s Timeline
•
Extended Referral Management capacity
•
Robust information to Medical Records from Clinicians
screening
•
Currently 84% of referrals in e-format
• 4,519,177 current running total
•
84% of all referrals are electronically managed on line either in
one or all locations across Tayside
What Happened Next and When?
• Introduction/migration of SCI-Gateway
• Pilot commenced 5th November 2007 completed May 2008
• Over 5377 referrals processed during pilot
• In addition referrals being received within Medical Records from
GP practices outwith Tayside
• Full training and roll-out to all Tayside practices following
successful pilot conclusion and review.
Referral Management
Select the location, specialty, protocol and
clinician
A digital photograph of a lesion is attach to
the referral…..
…and the referral is sent through the Gateway
…and arrives in RMS
The medical staff on call from screening in
dermatology receive the referral…
…and screen it
Upon screening, redirect referral to
Plastics – Skin Lesion ….
Gateway is updated accordingly ….
and referral now received by Plastics
The patient is booked into a clinic and the
status of the referral is raised to urgent
The new status of the referral is
sent back to the Gateway
In RMS the referral is printed and
the booking confirmed …
…and the final status is sent back to the Gateway
Locally Agreed Referral Pathways
•
Tayside Colorectal Service – protocol based referral introduced
pan-Tayside.
•
Tayside Skin Tumour Service – collaborative working with 3
disciplines (Dermatology, Plastics Surgery & Oral and
Maxillofacial with links to Ophthalmology) – Joint screening
with digital photographs, introduced across Tayside, into
agreed management algorithms.
•
Surgical Vascular Services – referral management pathway to
include vascular laboratory testing.
•
First Seizure Service – protocol developed and includes
mandatory information to risk manage the patient.
Colorectal Protocol Based Referral
storyboard – Key Information
Colorectal Protocol Based Referral
storyboard – Clinical Information………
SCI-Gateway referral Compliant with National
Standards
•
National ‘HEAT’ status updates electronically passing back to
SCI-Gateway from RMS for all patient referrals.
•
Tayside protocol modification to indicate – ‘Urgent Suspected
Cancer’ in accordance with 62 and 31 day Cancer pathways.
•
Facility to record UK Veteran status to allow appropriate
management of patients.
RMS Development
•
Generic screening options include ‘Any outpatient clinic,
redirection, up/downgrade, cancellation (clinical messaging
back to General Practice), flag-to (specific clinician or service).
•
Specialty generic email and/or clinician email alert for flagged
referrals.
•
•
•
Screening/Triage Clinician directed RMS ‘options’
E.g., Orthopaedics – Physiotherapy.
E,g., Medicine for the Elderly – Falls Clinic.
The Future
•
Complete alignment of referrals and referral management by all
specialties with integration with PAS, and delegated appointment
booking.
•
Clinical Directory to be developed and introduced containing
referral pathways and referral guidance.
•
Introduction of electronic test requesting and appointing.
•
The ability to attach documentation to the referral in secondary
care by April 2010 – developed specifically for the Pain services
to allow patient questionnaires to be electronically incorporated
with the original referral.
•
Clinical messaging back to General Practice from RMS through
the EDT server into Docman.
•
More Protocol Based Referrals to be developed following
consultation with General Practice and Secondary Care
The future continued……
•
SCI-Gateway referral by GDP and referral screening by
Hospital Dental Services.
•
Inter-Hospital Usage of SCI Gateway for tertiary referrals.
•
Development and adoption by Community Services of SCIGateway and RMS (referral screening) e.g. Dietitians,
Physiotherapy, Speech and Language therapy.
•
Inclusion of Mental Health Services in PBR development and
referral screening.
Comments by Clinicians on-line screening
Mr Amar Jain, Consultant Orthopaedic Surgeon,
(specialises in Orthopaedic Foot referrals).
• “I must admit I was a bit sceptical of whole system as I
am a technophobe and computer illiterate. But I am
pleasantly surprised how easy it was to get on it . After a
few teething problems for me now it is functioning very
well. Your and your colleagues’ support has been very
valuable for me. It has been very useful in screening
Foot referrals. This has made the whole admin of
referrals easy and faster. Even I can recommend to all
without hesitation.”
Dr James Cotton, Consultant Gastroenterologist.
•
“Prior to the implementation of RMS my colleagues and I had
some concerns if it would influence the way we worked on a
day to day basis of managing referrals: How we would manage
personal referrals and how would we screen referrals.
We have seen benefits in managing referrals since
implementation of RMS.
We can screen anywhere on our intranet, it is easier to
redirect referrals and to cancel them with feedback for the
GP. Referral rarely get lost!”
“From an audit point of view we can get better data regarding our
referral patterns, and management.
It did required a change in how we work and work as a team,
but we have seen the time to screen drop to a mean time of 1
day.”
“Future developments into integrating the system with other
hospital systems and results management would be welcome,
which I believe is currently being looked into.”
Some Challenges…
•
Customisation for individual specialties is labour intensive and
development requires considerable support.
•
Support Team needs to be fully integrated, good
communication in place to effect change.
•
In Tayside we still have a mixed economy – electronic and
paper based referrals and referral management.
•
Still new patient pathway development reliant on paper faxed
route for referral/management.
•
Expectations raised, ‘immediate development’ now requested.
•
Dealing with the ‘less keen’.
Doing things differently?
•
Reprioritise to HEAT – ref 2005
•
Roll out of two programmes at the same time – SCI-Gateway and
RMS.
•
Earlier link of RMS with PAS appointment booking.
•
Integration of patient demographics and administration data with test
requesting from RMS.
•
Communication strategy.
Questions & (Hopefully) Answers