What is ACRT?
Active Clinical Referral Triage (ACRT) is the process of adding value to the initial referral and vetting processes following a referral from primary care.
Traditional Referral Pathway
When a patient is referred for a specialist opinion a referral letter is usually sent which includes details of the patient’s history, examination findings, and the nature of the request. Historically, these referrals were made by post and involved subsequent paper based processes. More recently these have evolved to electronic communications that interface directly with hospital electronic patient records.
Following receipt of the referral, the most basic form of vetting is determining the clinical urgency and if sub-specialty review is required. Usually, the next contact with the patient will be the provision of an appointment. In systems with capacity constraints, this appointment can be many months later. In the intervening time the patient has no straightforward means of contact if symptoms deteriorate, or provision of information.
Active Clinical Referral Triage (ACRT)
ACRT brings value to the initial management of the referral, by providing extended options at the time of vetting:
- It enhances clinical prioritisation and sub-specialty direction, by review of multiple sources of information (i.e. Clinical Portal, EPRs, PACS)
- It allows the provision of information direct to the patient, prior to an appointment (patient information leaflets)
- It creates “opt-in” pathways, which can be accessed by a patient after considering the information provided
- It facilitates direct referral investigation (i.e. nerve conduction studies or endoscopy)
- It allows identification of suitability for remote consultation (telephone or video)
- Onward referral to a more appropriate specialty or treatment (i.e. physiotherapy)
ACRT can also be used to identify the most appropriate clinician for subsequent review:
- Clinical Nurse Specialists (CNSs)
- Advanced Practice Physiotherapists (APPs)
- Consultant medical staff
Early Provision of Patient Information and “Opt-In”
Patients do not usually receive any information about their condition until their actual consultation. With ACRT, information can be provided immediately after referral. This can take the place of leaflets or booklets, or sign-posting to multimedia resources such as websites or videos. In some cases this information may be sufficient to inform the patient about their condition and allow self-care. Where an actual consultation is still required, prior provision of information is important to allow an informed discussion of the available treatment options.
“Opt-In” is the process where a patient, after accessing this information, can indicate that they would still wish an appointment to discuss the information and treatment options. It can be achieved via a telephone line, email or other electronic means. The patient can then be provided with an appointment via normal outpatient waiting list practices. Such processes can help to reduce unnecessary appointments and un-utilised slots (DNA: did not attends).
How can Information Provision be Enhanced?
Information is usually provided in leaflets and booklets. However, these cannot be updated or personalised to each patient, and are associated with ongoing printing costs. In many cases information can be provided on poorly photocopied resources. Paper based leaflets are also limited in providing rich content such as videos and self-help websites. The costs associated with postal provision, particularly large or heavy resources, is also increasing. It is difficult and time consuming to audit or measure how effective the provision of information has been, along with how engaged the patient has been on the journey.
ConsentWise: The Solution
ConsentWise exists to facilitate the electronic provision of information about illness, healthcare and procedures. ConsentWise has a modular approach which allows it to be applied to ACRT processes with ease. Following referral from primary care, ConsentWise can be used to generate an email to a patient with a unique link. This takes them to the selected information resource. The system can track engagement with the information, assess feedback regarding satisfaction, or allow a patient to request a consultation.
Figure: ConsentWise at the heart of modern ACRT processes
ACRT is a patient focused revolution in how referrals from primary to secondary care are managed. New digital solutions are required to support these processes, to streamline administration and maximise engagement with content and ensure recoding of uptake and compliance for clinical audit and medicolegal purposes. ConsentWise is an ideal partner for departments who are embarking on an ACRT journey, or wishing to streamline existing established pathways.
Paul Jenkins MD FRCSEd(Tr & Orth) MFSTEd
Consultant Orthopaedic Surgeon
About the Author:
Paul Jenkins is a Consultant Orthopaedic Surgeon and Clinical Director of the Department of Trauma & Orthopaedic Surgery at Glasgow Royal Infirmary. He specialises in Shoulder & Elbow trauma and disorders. He has a wide research interest and has been involved with the development of virtual patient pathways in trauma and elective orthopaedic management. He has also provided expert witness opinion in a variety of pursuer and defender, civil and criminal litigation.
Paul Jenkins holds shares in Digital Consent Ltd and is on their Surgical Advisory Panel.