Safety and Quality: Referrals
You should be able to demonstrate that you provide appropriate and accurate information when you make a referral.
You are required to demonstrate that your referrals facilitate appropriate patient care. You can review the effectiveness (referring patients to the right services), efficiency (referring at the right time), or the content of your letters or other referrals (there are pro formas at the bottom of the page). SIGN 31, Report on a Recommended Referral Document was published in 1998, and has led to the development of electronic referral methods. These mean that much of the required information automatically populates your referrals.
We often find it difficult to objectively review our own referrals. In order to learn from your referrals it is sometimes helpful to discuss them with a trusted colleague.
What you decide to review will depend hugely on your situation. If you use an SCI Gateway system, and in your region the referral pro formas for all or most specialties are advanced, there may be little to be gained by reviewing content of referral letters. But if you work in the out-of-hours service and write all your referrals by hand, this could be extremely informative.
In some regions of Scotland, projects are developed to examine aspects of referrals thought locally to be important. If you are involved in such a project, data collected as part of this initiative could be presented with reflections upon relevance to your practice. Remember the data needs to have some personal relevance.
If you wish to identify a referral to a specialty for more detailed examination, consider requesting figures on your referral rates to one or more specialties and compare this with local and regional rates.
This review would be most suitable for manually constructed letters; there is little point in analysing the presence or absence of data that automatically populates your referral! However, review of emergency admission letters might be of value. You could review 10 consecutive anonymised emergency referral letters, using the pro forma below. Copies of the anonymised letters should be attached to this form to support your analysis.
If you are confident that your system allows for all relevant details to be incorporated into the referral document, you may wish to analyse the clinical information that you supplied. This analysis could apply to a series of 10 consecutive referrals, referrals to a clinical specialty, or to laboratory or radiology facilities. Copies of the anonymised referral documents, or the report forms for laboratory tests (provided that these reiterate the clinical details, which you supplied), should be attached. You will probably find that it is most useful to do this analysis with the result of the referral available.
You may feel that it would be worthwhile reviewing the efficiency of your referral system to one or all specialties. The pro forma below provides a method of surveying this. Remember to reflect upon what you can change, not what is outwith your control.
This module is intended to allow you to review your methods for handling the issues that may arise, and to reflect on any difficulties you may have faced, and the ways in which you might deal with them.
This page was last updated on: 15/05/2015
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