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BMC Health Services Research

, 13:310

Quality, performance, safety and outcomes


BackgroundReferral management centres RMC for elective referrals are designed to facilitate the primary to secondary care referral path, by improving quality of referrals and easing pressures on finite secondary care services, without inadvertently compromising patient care.

This study aimed to evaluate whether the introduction of a RMC which includes triage and feedback improved the quality of elective outpatient referral letters.

MethodsRetrospective, time-series, cross-sectional review involving 47 general practices in one primary care trust PCT in South-East England. Comparison of a random sample of referral letters at baseline n = 301 and after seven months of referral management n = 280. Letters were assessed for inclusion of four core pieces of information which are used locally to monitor referral quality blood pressure, body mass index, past medical history, medication history and against research-based quality criteria for referral letters provision of clinical information and clarity of reason for referral.

ResultsFollowing introduction of the RMC, the proportion of letters containing each of the core items increased compared to baseline. Statistically significant increases in the recording of ‘past medical history’ from 71% to 84%, p < 0.001 and ‘medication history’ 78% to 87%, p = 0.006 were observed. Forty four percent of letters met the research-based quality criteria at baseline but there was no significant change in quality of referral letters judged on these criteria across the two time periods.

ConclusionIntroduction of RMC has improved the inclusion of past medical history and medication history in referral letters, but not other measures of quality. In approximately half of letters there remains room for further improvement.

KeywordsGeneral practice Referral letters Quality improvement Peer review Referral management AbbreviationsGPGeneral practitioner

PASWPredictive analytics SoftWare

PCTPrimary care trust

RMCReferral management centre

RMSReferral management scheme

SAILSheffield assessment instrument for letters

SPSSStatistical package for the social sciences.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-13-310 contains supplementary material, which is available to authorized users.

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Author: Ally Xiang - Helen Smith - Paul Hine - Katy Mason - Stefania Lanza - Anna Cave - Jonathan Sergeant - Zoe Nicholson - Peter


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