Aim:
Incomplete general practitioner (GP) referrals cannot be triaged effectively, impacting on quality and timeliness of patient care. A regional Integrated Cancer Service (ICS), which monitors processes to improve cancer patient experience within acute health systems, and a Primary Health Network (PHN), which has established links to general practices, aimed to develop a collaborative approach to increase colonoscopy referral quality in areas targeted for improvement.
Method:
Initially, 110 colonoscopy referrals from 43 general practices were sourced from a public hospital’s medical records. Baseline referral completeness was assessed by calculating the proportion of the 110 referrals with each item required for triaging. These results were reported to a PHN Primary Care Coordinator, who provided targeted feedback on referral quality to regional general practices through direct visits and disseminating information. Subsequently, a further random sample of 48 colonoscopy referrals was sourced. Follow-up referral completeness was also assessed by calculating the proportion of referrals with each of the items required for triaging.
Results:
At baseline, the lowest proportions of referral completeness were observed for family history of colorectal cancer [yes/no] (46 referrals; 42%) and full information on stated reason for referral (61 referrals; 55%). Of 56 referrals stating a positive faecal occult blood test (FOBT), 38% had the FOBT result attached. The PHN Primary Care Coordinator alerted regional general practices to these gaps in referral completeness through targeted engagement. The post-engagement audit showed that the proportion of referrals with documented family history (yes/no) had risen to 52% while the proportion of referrals with full information on stated reason for colonoscopy had risen to 67%. Of the 28 referrals stating a positive FOBT post-engagement, 64% had the FOBT result attached.
Conclusion:
A collaborative partnership was developed between the ICS and PHN which, with the use of specific data, helped engage and inform GPs.