Setting

Although this audit was specifically designed for a psychotherapy service, the principles could be applied to any setting where referrals are processed via a triage system that involves practitioners from different disciplines, such as community mental health teams or child and adolescent mental health services.

Background

In recent years there has been a move towards team working and referrals are more likely to be made to a service rather than a named individual. The way in which these referrals are processed varies. In the case of the specialist psychotherapy service, referrals were processed by clerical staff and forwarded to a referrals manager, who presented them at a weekly meeting of therapists from different psychotherapeutic disciplines (cognitive, psychodynamic, psychoanalytic, humanistic, etc.). The referrals were then allocated to what was considered to be the most appropriate modality. There was a perception within the team that this system was inefficient, resulting in undue delays to first assessment.

Standards

The service was benchmarked against the standard set in The NHS Plan (Department of Health, 2000) that no patient should wait longer than 13 weeks for a first appointment for non-urgent treatment. The interval between the receipt of a referral and its discussion at a referral meeting was also audited against a locally agreed standard of 1 week.

Method

Data collection

All referrals to the service in a calendar year were examined.

Data analysis

The number of referrals and the number and proportion of patients given appointments for assessment were calculated. Waiting times (defined as time from receipt of referral to date of first appointment offered) and time to discussion in the referrals meeting were also calculated.

The audit was repeated following implementation of an action plan (see below). Differences in the mean waiting times between the first audit and the second audit were then examined for statistical significance using an independent-samples t-test in SPSS version 12.0.

Resources required

People

The audit collected data on all referrals in a calendar year (more than 300 referrals) and was undertaken by two people. A less ambitious audit is recommended.