Irish patients will benefit from reduced waiting times for referrals to consultant-led outpatient clinics when new recommendations published today by the Health Information and Quality Authority (HIQA) are implemented.

The Authority has published the Report and Recommendations on Patient Referrals from General Practice to Outpatient and Radiology Services, including the National Standard for Patient Referral Information.

The implementation of HIQA’s recommendations will mean that patients will benefit from improved access to diagnostic services and they will be able to easily find out how far their referral has progressed, when they can expect to receive an appointment, and get answers to any queries they may have in relation to their referral.

Timely, safe and equitable referral for patients depends on a number of key aspects including the quality of information provided in a referral letter. At present, there is no national agreement on the information which should be included in patient referral letters sent from GPs to hospitals. To address this deficit, and facilitate wholesale improvements in the quality and safety of care for patients, HIQA, in partnership with the Irish College of General Practitioners (ICGP), has developed a standardised template for use in patient referrals.

Speaking at the launch of the report, Professor Jane Grimson, Director of Health Information with HIQA, said: “At present in Ireland, there is significant variation in patient access to, and waiting times for, consultant-led outpatient services and diagnostic services. International best practice indicates that waiting times should be less than 90 days. However, according to HealthStat, only a very small number of Irish hospitals achieved this target in November 2010 in particular specialties, demonstrating considerable variation in the delivery of services.

“Against this background of significant national variation in patient access to outpatient and radiological services, long waiting lists for services and known deficiencies within the current referral system, we undertook this review on how patient referrals to outpatient and radiology services from general practice are managed and looked at how this could be improved.”

The report identifies issues which need to be addressed to improve access for patients and makes a series of recommendations aimed at improving the quality and safety of the referral system to outpatient and radiology services. Included in these recommendations are new national standards for the provision and communication of information throughout the patient referral pathway.Among the 26 recommendations contained in the report are:

• that the HSE should have clear patient referral pathways for outpatient and diagnostic radiological services to ensure consistent and equitable access to services for patients
• a requirement for patient referrals to be individually and collectively tracked and traced
• more effective communication with patients and service users regarding the status of their referral
• a focus on improved governance, leadership and management to enable the delivery of a high quality safe referral system.

Developed with the ICGP and supported by extensive consultation, this report also outlines benefits for GPs from the introduction of an improved referral pathway. These include the involvement of GPs in the management of patient referrals at a local level, improved access to outpatient and radiological services for their patients, more accurate and up-to-date information on waiting times for services and a reduction in administration as a result of clearer contact mechanisms with services.

In accordance with its statutory standards-setting function, as part of this report, the Authority has also developed a Standard in the form of a patient referral template that will improve the information in patient referral letters leading to a more effective assessment of patient referrals by hospital consultants. This Standard, the National Standard for Patient Referral Information, has been submitted to the Minister for Health for approval.

The report is available to download from www.hiqa.ie. You can also find us on Facebook and Twitter by searching ‘HIQA’.

Further Information: 

For further information please contact:
Marty Whelan, Head of Communications and Stakeholder Engagement
01 8147481/ 086 2447623 or email mwhelan@hiqa.ie

Notes to the Editor: 

What implementing the recommendations mean for patients:

• improved access to information regarding consultant outpatient services to support patient choice
• access to information regarding waiting times for consultant-led outpatient services
• reduction in time to process referrals
• reduction in waiting time to first appointment
• improved access to radiological services where appropriate
• clarity regarding who to contact with queries regarding their referral
• appointments with the consultant with the most appropriate experience and training to manage their condition.

What implementing the recommendations mean for GPs:

• improved communication with their hospital colleagues and improved input into patient-referral pathway design with their local hospitals
• reduction in time to process referrals
• access to improved information on waiting times
• improved access to radiological services for their patients
• specific point of contact within hospitals to manage clinical and administrative queries
• improved flow of information from the hospital
• input into patient-referral pathway governance at a local and national level
• reduction in number and variation of referral forms
• improved support for electronic referrals.

What implementing the recommendations mean for hospitals:

• improved management and governance of the patient-referral system
• improved information in referral letters
• centralised administration of referrals
• referral to specialty or service rather than to a named consultant
• improved communication between clinicians and administrative staff within the hospital
• centralised point of contact to manage patient and GP queries
• better management of information relating to referrals
• increased use of electronic means of delivery of GP referrals to the hospital.

In 2009 in Ireland there were approximately 3.3 million attendances of patients at consultant outpatient clinics and approximately 900,000 of these where for first appointments at consultant-led clinics. This gives a clear indication of the scale of information transfer and treatment provision involved in the delivery of these services, impacting on a large proportion of the population.

Information from HealthStat (the Health Service Executive’s performance information system) on international best practice indicates that waiting times should be less than 90 days. However, only 6 of the 22 Irish hospitals which submitted data to HealthStat achieved this target with anecdotal evidence suggesting that waiting times for some services can be up to four to five years in some cases.