P318 electronic referral grading system that puts patients and clinicians first

Wood, Samuel, Bhandari, Megha, Borca, Florina, Barnes, Liz, Hendy, Ben, Coleman, Nicholas, Stacey, Bernard, Felwick, Richard, Stammers, Matt and Gwiggner, Markus (2022) P318 electronic referral grading system that puts patients and clinicians first. Gut, 71, [A194]. (doi:10.1136/gutjnl-2022-BSG.369).

Abstract

Introduction: the NHS Long Term Plan estimates demand for gastroenterology outpatient appointments (OPA) will continue to increase with the Royal College of Physicians deeming up to 20% of new referrals unnecessary. Bespoke electronic referral grading provides direct access to all community and hospital electronic patient records allowing fully informed immediate decision making. This can avoid unnecessary OPAs by redirecting/rejecting and sending appropriate patients direct-to-test while getting the right patient to the right clinician through sub-speciality tagging.

Methods Outcomes: proportion/number of first OPA appointments saved, time to first appointment and subspecialty focus. Pre-grading period: Sep 2018–Mar 2020. Post-grading period: Aug 2020–Feb 2022. The separate 2WW IDA pathway was excluded. Cardiology/rheumatology were used as controls. Wait in days at the 50th percentile was calculated. One-tailed Mann Whitney U test calculated statistical significance at the p<0.05 level. Number of appointments saved per year and resultant financial implications were estimated.

Results: GI received 3,768 consultant-graded referrals (Sep 2018–Mar 2020) and 3,908 (Aug 2020–Feb 2022).

Referral sub-specialty groupings:

1) Inflammatory Bowel Disease–765(19.6%)

1. Irritable Bowel Syndrome–755(19.3%)

2. Upper GI Diseases–753(19.3%)

3. Non–IBD Colorectal–426(10.9%)

4. Non–2WW Iron Deficiency Anaemia–345(8.8%)

5. Unexplained Weight Loss–165(4.2%)

6. Surgical/Hepatology–159(4.1%)

7. Coeliac–139(3.6%)

8. Endoscopy–126(3.2%)

9. Complex Functional–106(2.7%)

10. Not Tagged–88(2.3%)

11. Intestinal Failure–81(2.1%)

Documented referral rejection rates increased from 1% to 19% (n=745/3908) in the second period. 456 (11.6%) of patients were diverted directly to endoscopy, cumulatively saving 30.7% (n=1201) first OPA appointments equivalent to 150 new patient clinics. Total savings = £101,731/year in first GI OPA alone given the current block contract structure. Time to first appointment reduced by 58% but no improvement was seen in comparator specialties: [P318 Table 1
Clinic wait times compared @ the 50th percentile not included].

Conclusions: use of a consultant-led electronic grading system had dramatic effects on the quality of data collected and significantly reduced first OPA waits at the trust. The reasons for this were triage direct-to-test and proactive rejection/redirection of referrals using sub-speciality tagging to get the right patient to the right clinician.

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