The document discusses the implementation of an electronic referral (eReferral) system across primary and secondary care in the UK. It was implemented in phases from 2009-2013, becoming fully electronic in June 2013. The eReferral system has led to faster processing of referrals, with median triage times of under 1 day for many specialties. It has also improved appropriate referrals, allowing 20-25% more specialist input without increasing wait times. Instant messaging between GPs and specialists has helped ensure patients are referred to the right clinics. The system has changed how care is delivered through increased shared care planning and management of patients within primary care supported by specialists.

1. Electronic Triage:
The pots of gold at the
end of the referral
rainbow •Di Davis November 2013

2. Background
•
Primary-Secondary Care initiative
•
Driver = Primary care alignment+ safe
transmission
•
9 month development phase
•
Roll-out initiated March 2009
•
100% electronic from 1st June 2013

3. Phased approach
Phase 1 - March 2009
Document generation
Electronic transmission
Receipt acknowledgement
Phase 2 – May 2012
Electronic triage
Response to referrer

4. Total ereferrals - March 2009 to present
4500
Phase 2 - electronic
triage
1500
End of paper - June
2013
4000
Phase 1 - electronic transmission
3500
3000
2500
2000
1000
500
0
13
ptSe
3
l-1
Ju 3
y-1
Ma
3
r-1
Ma
3
n -1
Ja
2
v-1
No
12
ptSe
2
l-1
Ju 2
y-1
Ma
2
r-1
Ma
2
n -1
Ja 1
v-1
No
11
ptSe
1
l-1
Ju 1
y-1
Ma
1
r-1
Ma
1
n -1
Ja 0
v-1
No
10
ptSe
0
l-1
Ju 0
y-1
Ma
0
r-1
Ma
0
n -1
Ja
9
v-0
No
09
ptSe
9
l-0
Ju 9
y-0
Ma
9
r-0
Ma

5. Change in the processing
times:
Colorectal referrals
Paper
9.8 days
Electronic to the Electronic to the
door
specialist
4 days
<1 day

6. A fast service
Service
Median time to triage (days)
August
September
October
Cardiology
0. 5
0.42
0.67
Respiratory
0.75
0.29
0.69
Ophthalmology
1.54
2.06
1.0
Paediatrics
1.83
1.06
2.13
Renal
0.71
0.92
0.75
Gynaecology
0.67
0.33
0.71
Orthopaedics
10.00
14.96
20.4

7. e-referrals vs FSA appointments - core
specialities
3000
2500
2000
1500
1000
500
Total FSA Delivered
E-Referrals Edited
0
M
ar
Ju
Se
De
M
ar
Ju
Se
De
M
ar
Ju
Se
De
M
ar
Ju
Se
De
M
ar
Ju
Se
-0 n-0 pt- c -0 -1 n-1 pt- c -1 -1 n-1 pt- c -1 -1 n-1 pt- c -1 -1 n-1 pt9
0
1
2
3
9 09 9
0 10 0
1 11 1
2 12 2
3 13

8. total patients on FSA waiting list for "core
specialties"
4500
4000
3500
3000
2500
2000
Se
pt
3
3
13
-1
g-
l- 1
Au
Ju
13
3
3
-1
n-
ay
Ju
M
3
13
-1
r -1
ar
Ap
M
b-
13
2
2
12
12
v-
c-
n-
Fe
Ja
De
No
2
12
-1
t -1
pt
Oc
Se
g-
l- 1
Au
Ju
12
2
2
2
-1
nay
Ju
M
-1
r -1
ar
Ap
M
12
12
bn-
Fe
Ja

9. 400
eReferrals managed with non contact specialist
advice
350
300
250
200
150
100
50
0
3
-1
3
-1
3
13
pSe
l
Ju
ar
-1
12
3
-1
ay
M
M
n
Ja
vNo
2
-1
12
pSe
l
Ju
2
-1
ay
M

10. Instant messaging
Enabled more appropriate triage
outcomes

11. Instant messaging
Enabled more appropriate triage
outcomes
More appropriate people in clinic

12. Instant messaging
Enabled more appropriate triage
outcomes
More appropriate people in clinic
Change in GP referring behaviour

13. Instant messaging
Enabled more appropriate triage
outcomes
More appropriate people in clinic
Change in GP referring behaviour
Is it meeting the GP and patient need?

14. Key points
Rising referral numbers with no negative impact on
clinics or waiting lists

15. Key points
Rising referral numbers with no negative impact on
clinics or waiting lists
20%-25% growth in specialist input within current
resource

16. Key points
Rising referral numbers with no negative impact on
clinics or waiting lists
20%-25% growth in specialist input within current
resource
More appropriate patients in clinic ( top of scope)

17. Key points
Rising referral numbers with no negative impact on
clinics or waiting lists
20%-25% growth in specialist input within current
resource
More appropriate people in clinic (top of scope)
GPs managing more within the medical home with
specialist support ( top of scope)

18. Key points
Rising referral numbers with no negative impact on
clinics or waiting lists
20%-25% growth in specialist input within current
resource
More appropriate people in clinic (top of scope)
GPs managing more within the medical home with
specialist support ( top of scope)
Non contact input meeting the needs of both GP
and patient

19. Is more possible?
? yes, reframe concept of triage

20. Process “pots of gold”:
Standardised work
Flexible work
Accountability/ownershi
p
No wrong door

21. Process “pots of gold”:
Standardised work
Flexible work
Accountability/ownershi
p
No wrong door

22. Process “pots of gold”:
Standardised work
Flexible work
Accountability/ownership
No wrong door

23. Process “pots of gold”:
Standardised work
Flexible work
Accountability/ownershi
p
No wrong door

24. People “pots of gold”
Relationships: GP:SMOs

25. People “pots of gold”
Relationships: GP:
SMOs
Clinicians driving "next
steps"

26. The new paradigm…..
Shared care
Primary/secondary
clinical conversations
Shared
planning
eReferrals
Clinical pathways/
guidelines