Improving your referral pathway and admin systems
Ensuring you have the most effective and efficient referral pathway is equal to ensuring a quality programme. There are many different techniques that can be implemented as part of your local referral pathway, and it is really important to consult with all stakeholders when designing or adapting this for your local area.
Traditionally, referral pathways and associated forms have been paper-based, however over recent years many organisations have moved to a more-paperless approach with the integration of referral forms and criteria into GP systems to ensure speed of referral and accuracy of data captured as such system can often be set to self-populate the necessary data fields. We would love to build a repository below of example pathways and forms to help new organisations during set-up and also existing DESMOND Providers when going through service redevelopment. So send over any examples you have an we can get them added .
What you can embed in your pathway will depend on the resources you have available to you – our advice will always be to try to make it as simple as possible for the referrer, however, if they understand the reason for completing something more complex then they may be more willing to refer.
It is good to think outside the box in terms of where your referrals could come from. For example, podiatry or retinal screening services have been a good source of referrals in some parts of the UK.
An integrated electronic administration system would be the gold-standard. It is definitely worth investigating the practicalities of implementing a system that includes ‘pop-ups’ on GP screens, a referral made via the click of a single button, and that is automatically populated with patient contact information and data. This can then link directly to a central administration system at the coordination office, allowing for a smoother transition and hopefully reducing waiting lists due to a reduction in administration requirements. A central electronics admin system could include all or some of the following actions:
Automatic letter generation on assigning a course date to a patient
Automatic generation of signing-in sheet for each course
Automatic text reminders to patients who have supplied mobile phone numbers #
Automated email creations especially for groups being held virtually
Automatic creation of reports, including reporting back to GP/referrers on attendance and DND/decline rates at month end
An existing example of an integrated electronic system has been developed by NHS Leicestershire Health Informatics Service called PRISM (Pathways and Referral Implementation SysteM). PRISM works alongside other clinical systems (such as SystmOne and EMIS) to streamline referral pathways and make the process more efficient and effective for the referrer, the administrator and the patient. Visit https://www.leics-his.nhs.uk/products/prism/ for more information.
An example of good practice touched upon in the above points, which is especially worth considering when establishing your pathway, is to include feedback to the referrer, to ensure that they are informed of who did and who didn’t attend/register. Guidance on the recording of referral and attendance on diabetes education; can be found via https://diabetes-resources-production.s3-eu-west-1.amazonaws.com/diabetes-storage/2017-08/Std_Approach_Guide_v10.pdf (please note it is envisaged that this may change with the introduction of more digital offers for diabetes education)
As you can see in this guidance, and below, general read codes have been agreed for the different clinical systems. We would recommend that providers look to include the specific read code in their referral feedback, which will aid quick and accurate data capture. This reporting could be entered automatically if your system is sophisticated enough to have two-way communication with the GP clinical systems.
