A structured referral pathway has helped reduce haematology waiting times in a large tertiary centre despite increased referrals, the recent Haematology Association of Ireland (HAI) Annual Meeting was told.
During a presentation, Dr Camillo Coccia, St Vincent’s University Hospital, Dublin, informed the meeting, which took place on 10–11 October in Athlone, Co Westmeath, about a closed-loop audit carried out at the hospital on the new pathway.
Dr Coccia, a Registrar in Haematology, told the meeting that there had been an “explosion” in referrals to haematology specialist services and that this was a global problem.
The trend is multifactorial, driven globally by an ageing population, the expansion of available treatments, advances in diagnostic scope and sophistication, and the growing complexity of patient cases.
As a result, clinic waiting times have lengthened, creating added pressure to triage urgent referrals, accommodate priority appointments, and determine how best to manage long-term follow-up.
“Especially, given that many of these patients will require tertiary-centred follow-up with specialist care,” he said. This global increase was reflected in a 2021 audit conducted at St Vincent’s examining the number of clinic attendances from 2007 to 2021.
Dr Coccia outlined that between 2017 and 2021, there had been a significant rise in the number of people waiting more than 12 months for a clinic appointment.
“This was recognised at a national level and national solutions were put in place,” he said.
The national 2017 Waiting List Action Plan aimed to reduce clinic waiting times to less than 10 weeks, “which is ambitious and the target was across all disciplines and all specialties.”
Local solutions at the hospital saw the service expanded. An additional consultant and NCHD were recruited. A fifth weekly clinic was added, as was a National Treatment Purchase Fund-supported clinic.
A structured referral pathway was also introduced, which outlined referral guidelines, including guidance on urgency, and initial work-up.
These initiatives worked well, according to Dr Coccia, and resulted in a fall in waiting time breaches by 2022.
The audit found that breaches over 12 months dropped by 35 per cent in 2021 to less than 1 per cent in 2022, with the median waiting time reduced from 97 to 63 days.
This is despite a 42 per cent increase in referral burden, Dr Coccia said. The guidance also improved referral appropriateness, with fewer inappropriate referrals to clinics. In addition, some of the consultants’ decision-making workload was offset by the written guidelines.
A 2025 re-audit of 2022-2024 data took place to ensure ongoing compliance, identify any new issues or delays arising from the referral system, and examine the reproducibility of the pathway.
“It was a retrospective review categorising the referrals of those patients requiring an appointment, those requiring triage or more investigations, or those who would be discharged directly to their GP,” he said. “And comparing them to previous audits.”
The results showed an increase in the amount of clinic attendances, but the number of patients waiting for more than 12 months was still at zero per cent in 2024. The meeting heard that there had been an overall increase in the number of appointments from 2022 to 2024 of 42 per cent, rising from under 1,500 to more than 2,000.
“Those requiring an appointment increased by only 26 per cent, reflecting the strength of the structured referral pathway,” he said.
The re-audit of the pathway found that haematology referrals continued to expand yearly. However, breaches of the 12-month waiting time period continued to be at zero per cent, the meeting heard.
According to Dr Coccia, future service development could include an expansion of Advanced Nurse Practitioner-led clinics and rapid access haematology clinics, as well as the digitisation of the referral and triage workflows. Ongoing audits are important to ensure sustainability, he said.
Dr Coccia told the meeting it was known that haematology referrals would continue to grow, but that structured referral pathways and service expansion can lead to sustained improvement. He added how system redesigns coupled with leadership interventions can meet national targets.
In addition to continuous re-audits, updated written guidelines are also crucial to this integrated care model.
During the discussion, delegates noted a significant rise in GP referrals to haematology services, many of which were considered inappropriate. See conference coverage
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