Basic flaws in management of outpatient referral data

An audit of hospitals’ management of outpatient referrals found “wide variation in compliance with the capture of key dates in the processing and triaging of referrals”, the Medical Independent has learned.

The audit was conducted by the National Treatment Purchase Fund (NTPF) in 2023. It showed that basic protocols in the management of outpatient referrals were not being followed by all hospitals.

The audit report, dated March 2024, examined six unidentified hospitals across the country. Some 237 patient referrals were surveyed as part of the process.

The exercise aimed to examine compliance with the enhanced national outpatient waiting list management protocol (March 2022). It also aimed to assess compliance with the clinical prioritisation (triage) process against the national protocol and to identify issues impacting the accuracy of waiting list data.

The NTPF publishes national monthly waiting list data and requires accurate information from hospitals on outpatients awaiting care.

The audit examined the ‘referral received date’, which is the day the referral is received and stamped and marks a patient’s start time on the outpatient waiting list system. The correct ‘referral received date’ must be recorded.

“For 99 per cent of referrals reviewed the referral received date was recorded, however, only one hospital achieved full compliance in entering the correct date on PAS [patient administration system].

“For 71 per cent of referrals reviewed, the referral received date matched the date entered on PAS. For 28 per cent of referrals, the date was incorrectly entered on PAS. The impact on the patients’ start wait-time on the OPWL [outpatient waiting list] ranged from one to 17 working days, however for two patients the delay was significantly longer,” according to the audit report.

“For one patient, where the referral was redirected from another hospital with a shared service, the patient’s start time on the OPWL was 142 working days after the referral was initially received and stamped. For another patient, the start time on the OPWL was 65 days after the referral was initially received and stamped by the hospital.”

Some 53 per cent of referrals reviewed were added to the OPWL within the recommended one working day. For the remaining 47 per cent, timeframes ranged from two to 66 working days.

Regarding the wide variation in compliance with the capture of key dates, the audit found that the dates were either “not recorded on the referral or entered on PAS, or dates were entered on PAS without the required information recorded on the referral. The lack of dates on the referral or entered on PAS limited testing and therefore audit findings.”

The report outlined 13 recommendations for implementation in all hospitals. An NTPF spokesperson said oversight for addressing the recommendations “is with the HSE”.

However, a HSE spokesperson said this was a matter for individual hospitals. It was unable to provide information on the implementation of the NTPF’s recommendations.