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Consultant to consultant referrals

The SWLEOC Performance Team is responsible for coordinating the Consultant-to-Consultant referrals into all Orthopaedic Sub-Specialities. This is an internal process using the Clinical Manager patient record and via the Outpatient Booking Centre based in the host trust.

Referrals into Orthopaedics:

  • a patient is reviewed in a Consultant Clinic which may be in any speciality;
  • the Consultant generates a Consultant-to-Consultant referral on Clinical Manager if they are seeking a review from another speciality or a second opinion;
  • the (Outpatient booking Centre (OBC) based in the Main Trust receives all con-con requests and this will be sent to the relevant speciality/clinician for triage;
  • the SWLEOC Outpatients team receives the referral from OBC based on subspeciality. This will then be forwarded to the Performance Team to coordinate the triage process;
  • if accepted, the Performance Team arranges the first outpatient appointment with the relevant Consultant. The referral paperwork is automatically uploaded onto Clinical Manager and Patient Manager;
  • the clinic letter dictated by the clinician, as a record of their consultation, must be available at the point of Triage so that all clinical details are available;
  • if declined, this referral is sent back to Triage Bookings, with a note as to why the referral was rejected.

 

Referrals from Orthopaedics into other specialities:

  • if the referral is rejected by the receiving speciality, the Performance Team will become aware of the rejection when validating the Patient Tracking List;
  • the Performance Team will contact the referring Consultant to make them aware and request their opinion on the next steps of the patient’s care. This may be to review them again if they have not been discharged, or to contact the Consultant within the receiving speciality to discuss as an MDT;
  • the Performance Team action based on the Consultant’s decision.

This current process started in 2021 and has evolved from paper referrals via internal post to the Clinical Manager electronic referral process. The Con-Con process was managed by the Outpatients Team who continue to manage the patients requiring follow up within Orthopaedics. If the referral is a new referral to Orthopaedics from another speciality, this first appointment will be booked by the Performance Team.

  • Outpatients;
  • Consultants;
  • Registrars;
  • Fellows;
  • Therapy Team Leads;
  • Advanced Nurse Practitioner;
  • OBC;
  • Radiology

In an office space within SWLEOC Management Offices, the Performance team carries out this function.

  • Clinical Manager;
  • Patient Manager;
  • Bluespier;
  • Dictate IT3;
  • Dictate IT2;
  • Emails
  • The delay in the process of having clinic letters approved and uploaded onto Clinical Manager;
  • Consultant-to-Consultant referrals sometimes do not include enough information for the triaging clinician to make an informed decision;
  • if the referring clinician has requested diagnostics at the same time, this may delay the triage process if the diagnostics has not occurred, or the report is not available.
  • Identify the reason for delay and contact the relevant individual/team;
  • based on the available information, the Consultant can triage to an outpatient appointment as the images will be available by the time the patient is seen in the clinic.
  • When the con-con process was on paper, there were incidences of lost referrals, and these were not tracked effectively.
  • Lack of clinical information and reason for referral on the referral paperwork;
  • delay in clinic letters being completed, approved and uploaded on Clinical Manager;
  • difficulty in identifying when patients are rejected and time consuming to follow up and ensure the treatment plan is actioned for the patient;
  • waiting for diagnostics and ensuring that the patient has an appointment date for diagnostics;
  • intermittent duplication between the Performance and Outpatient Team.
  • To have a streamlined and efficient electronic pathway;
  • ensure that the patient pathway is tracked so that the patient does not get lost to follow up;
  • having a dedicated team responsible for coordinating the con-con process;
  • having strong communication links and relationships with all departments including OBC, Radiology and Triage.

The electronic consultant-to-consultant process.

The electronic process has resulted in additional steps at times with multiple teams managing the patient’s pathway.