NHS advice and guidance - improving outpatient flow and patient care in general surgery

Abstract

Introduction: Advice and Guidance (A&G) is a digital communication tool that allows primary care physicians to seek advice from secondary care clinicians prior to, or instead of, direct referrals. Its effectiveness in general surgery has not been robustly evaluated.

Aims: To analyse the number of A&G e-referrals to General Surgery at the Queen Elizabeth Hospital Birmingham and evaluate the outcomes of these requests including response times and changes to outpatient clinic appointment requirements.

Methods: A retrospective analysis of all A&G requests to General Surgery between July 2020 and September 2021. The responses were categorised into 7 different outcomes and the time taken to reply to requests was recorded. An analysis of outpatient appointments (both 'new' and 'follow-up' appointments) pre- and post-introduction of A&G was performed.

Results: A total of 2244 A&G requests were made during the study period: 61% requests resulted in outpatient clinic appointments; 18% direct organisation of investigations; 10% advice was provided; 8% were redirected to a different specialty. Median time take to reply to a referral was the same day. The proportion of outpatient appointments that were 'new' appointments was reduced by 16.3% following introduction of A&G (P < 0.001).

Conclusion: A&G requests to General Surgery potentially diverts patients away from the outpatient clinic. Responses are rapid. A longer term evaluation of the service is necessary to determine its beneficial and detrimental effects on patients, primary care and secondary care.

Keywords: Advice and guidance; NHS electronic referrals.