Referrals from acute care to community services improved dramatically once Rotherham Foundation Trust put a new referral system in place

Woman doctor, sitting at desk

Rotherham, introduced e-referral software, which helps match patients to services

A few years ago, referring a patient to community services from the acute care of Rotherham Foundation Trust could be a highly frustrating experience. Referrals were made by fax, with little guarantee that the multiple page documents would be safely received, let alone accepted.

‘Patient centred, coordinated care is increasingly the main aim for health and social care in the UK but many organisations are struggling to make it a reality’

A five month audit carried out in 2010 revealed the reality of the situation. Of 114 referrals made, 22 failed to reach teams within community services; of those, 13 had to be refaxed while nine completely failed. In these instances, patient discharge was delayed, with patients spending, on average, an additional two days waiting in an acute bed. This was not merely a problem for the trust but also led to significant patient and carer frustration.

Even those referrals that did reach the team were not necessarily successful. During the audit period, 24 per cent were rejected – reasons ranged from illegibility to the patient being unsuitable for the services of the team.

It was a situation that was damaging the trust and the local council’s ability to provide truly integrated care. Patients were rarely moving seamlessly from one service to the other, but instead were becoming ‘stuck’ at points in their journey through services.

“Patient centred, coordinated care is increasingly the main aim for health and social care in the UK,” explains Clint Schick, managing director of Strata Health, a company thats uses technology to improve the flow of patients across both sectors. “But many organisations are struggling to make it a reality.”

At Rotherham, the answer proved to be the introduction of e-referral software, which helps match patients to services. Referral forms are now completely standardised, transmitted electronically, and clinicians are given advice on appropriate services for their patients. This applies not just to community services but to local authority provision as well.

Dramatic improvements

An audit once the system had been introduced showed significant improvement. Of the 1,034 patients referred to community care teams between November 2010 and June 2011, there were no failed referrals – all reached the team. Similarly, the number of rejected referrals significantly fell – just five per cent were declined, and all for a good reason.

‘It took just seven months for failed referrals to fall to zero and to go from 25 per cent of referrals being declined to less than five per cent’

“It took just seven months for failed referrals to fall to zero,” explains Mr Schick, whose company developed and supports the e-referral system used by Rotherham. “Meanwhile they moved from 25 per cent of referrals being declined to less than five per cent.

“That change has not only significantly improved patient experience, giving the coordinated care they are understandably demanding, but it’s saved the organisation significant amounts of time and money.

“During the initial study period, 392 acute bed days were saved. When you consider that the trust sends more than 5,000 referrals each year, we anticipate annual economic efficiency savings of more than £1.5m in acute bed access.”

There have been savings too for the borough council, which runs the intermediate care provision to which those at the trust refer patients. By ensuring those patients are appropriate for such services, and by having clear visibility thanks to the electronic system, it has been possible to cut average length of stay in intermediate care beds and increase occupancy to 100 per cent. The council’s performance in intermediate care is now in the top quartile for comparable councils.

“Intermediate care can be difficult to commission, and difficult to keep at high occupancy, yet there is significant evidence that these sort of services reduce prolonged acute inpatient stays and long term residential care packages,” explains Mr Schick. “In Rotherham, occupancy is now a rolling 100 per cent, from historic lows of 47 per cent.”

The ageing population and the desire to reduce the use of acute care means the need for intermediate care is likely to surge in the coming years. It also means other organisations will need to address the efficiency of referrals from one sector to another.

“The value of this sort of joined up care is clear,” argues Mr Schick. “Providers are benefiting, and patients are too. Patient centred coordinated care is going to become an accepted standard in UK health and social care, and organisations need to start seriously looking at how they are going to make it a reality.”