title: An evidence-based referral management system: insights from a pilot study.
abstract: OBJECTIVE
  Improving the informational quality of referrals from primary to secondary care and appropriately re-directing referrals is an important goal of clinical commissioning groups in England. Based on the available empirical evidence, a referral management and booking service that combined referral guidelines, online referral templates and administrative and clinical triage, was developed by a primary care trust in southeast London.
  
  
  METHODS
  A pilot study of 13 out of 46 practices in the trust was conducted using a mixed methods approach. Referral numbers were investigated by analysing changes in practices' rates of first outpatient attendances in secondary care. Informational referral quality was assessed by analysing triage outcomes. Semi-structured interviews were used to inquire about practices' evaluation of the new system. Structured telephone interviews were conducted to assess patients' satisfaction.
  
  
  RESULTS
  Overall rates of first outpatient attendances declined more strongly for pilot practices than controls. The number of referrals challenged for being incomplete or having insufficient clinical information decreased. The rate of referrals challenged by clinical triage for not conforming to referral guidelines was well below the rate of inappropriate referrals published in the literature. Interviews with practices revealed a number of themes and a broad range of attitudes. Patients were highly satisfied.
  
  
  CONCLUSIONS
  Findings provided favourable evidence for the effectiveness of the new referral management system. They were, however, preliminary. If referrals into secondary care continued to be reduced on a long-term basis, the system would be cost effective despite the time and effort required for clinical triage.
authors.affiliation: 1Department of Primary Care and Public Health Sciences,King's College London,London,UK.
authors.forename: Ellen
authors.initials: E
authors.lastname: Wright
authors.affiliation: 1Department of Primary Care and Public Health Sciences,King's College London,London,UK.
authors.forename: York
authors.initials: Y
authors.lastname: Hagmayer
authors.affiliation: 2NHS Greenwich CCG,London,UK.
authors.forename: Irene
authors.initials: I
authors.lastname: Grayson
mesh_terms: D019317:Evidence-Based Medicine / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data*; D006801:Humans; D008131:London; D010865:Pilot Projects; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D063127:Secondary Health Care / Q000706:statistics & numerical data*
keywords: decision support systems; management; patient care management; practice guideline; referral and consultation; triage