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An observational study of timing versus appropriateness of acute plastic surgery referrals in the UK
1Leeds General Infirmary, Leeds, United Kingdom. fulvio@doctors.org.uk
Insights
UK Accident and Emergency (A&E) referrals to Plastic Surgery were quicker for inappropriate cases, suggesting non-clinical reasons may influence timely patient transfers. Review times did not impact A&E waiting targets.
Area of Science:
- Healthcare Management
- Surgical Referral Pathways
- Emergency Medicine
Background:
- UK government mandated 4-hour treatment target for all Accident and Emergency (A&E) patients.
- Challenges exist for A&E departments and referral services to meet waiting time targets.
- Concerns raised about referral appropriateness versus A&E overcrowding pressures.
Purpose of the Study:
- To investigate referral times and review times for Plastic Surgery referrals from A&E.
- To examine the relationship between referral timeliness and appropriateness.
- To assess factors contributing to A&E waiting time target breaches.
Main Methods:
- Prospective examination of 'Referral Time' and 'Review Time' in a UK teaching hospital.
- 'Referral Time' defined as A&E arrival to Plastic Surgery referral.
- 'Review Time' defined as referral to Plastic Surgery Senior House Officer review.
Main Results:
- Mean Referral Time was 84 minutes; mean Review Time was 33 minutes.
- Review Time did not significantly differ between appropriate and inappropriate referrals (p=0.357).
- Referral Time was significantly shorter for inappropriate referrals (92.8 min) than appropriate referrals (62.7 min) (p=0.028).
Conclusions:
- Review Time did not significantly contribute to A&E waiting time target breaches in this study.
- A correlation between shorter Referral Time and decreased appropriateness suggests non-clinical referral reasons.
- The 4-hour A&E target may lead to tactics prioritizing throughput over clinical need, warranting reconsideration.
Aim:
A commitment made by the UK government that all patients presenting to Accident and Emergency (A&E) should be treated within 4h of arrival has challenged both A&E departments and those to whom they refer. It has been suggested on one hand that referrals from A&E are not always seen promptly enough to meet waiting time targets, and on the other hand that referrals are sometimes made to help busy A&Es clear their waiting rooms rather than through clinical need.
Methods:
To investigate these claims 'Referral Time' (the time between a patient arriving at A&E and being referred to Plastic Surgery), 'Review Time' (the time taken from referral to review by the Plastic Surgery Senior House Officer) and their relationship with referral appropriateness were prospectively examined in a UK teaching hospital.
Results:
The mean Referral Time was 84 min (SD=57.3) and Review Time was 33 min (SD=27.4). Review Time did not vary significantly between 'appropriate' and 'inappropriate' referrals (31.3 vs 36.1 min, p=0.357) but Referral Time was significantly quicker for 'inappropriate' than 'appropriate' referrals (92.8 vs 62.7 min, p=0.028).
Conclusion:
This data suggests that Review Time did not significantly contribute to the risk of patients breaching the A&E waiting time target in this study, but a correlation between reduced Referral Time and decreased referral appropriateness is consistent with referrals sometimes being made for non-clinical reasons. It is felt that such tactics are an inevitable consequence of an unachievable target placed on A&E departments and that this target should be reconsidered.