Service evaluation of referrals to secondary care: A question of complexity?

To evaluate referral patterns to secondary care and categorise referrals by complexity level. To assess compliance with commissioning guidelines for cases accepted for treatment in secondary care, comparing complexity to Index of Orthodontic Treatment Need (IOTN) data.

Service evaluation of all referrals during study period recorded prospectively. The standard was set that >85% of cases offered treatment in secondary care should be complexity level 3b.

Seven NHS orthodontic departments within a regional clinical effectiveness group in secondary care in England.

All patients seen as new referrals during the three-month study period.

Data recorded at clinic appointment on data collection proforma including referral information, complexity, IOTN and outcome of the first appointment. Data were collated on a spreadsheet and simple statistics were applied.

A total of 493 patients were included in data analysis. Median waiting time for a new patient appointment was 11.0 weeks. For the whole study group, 53.8% were IOTN 5, 30.8% IOTN 4, 9.7% IOTN 3; complexity levels were 54.2% complexity 3b, 37.1% 3a and 6.7% 2. Of the patients, 30.0% were offered treatment in secondary care at their first attendance; of these, 74.3 % were IOTN 5, 93.2% were complexity level 3b.

The gold standard has been met in the region as a whole and at each individual unit. There is a large discrepancy between the IOTN score and complexity level in those patients offered orthodontic treatment in secondary care. Routine recording of complexity level is recommended for all patients seen in the secondary care setting.