This audit will be particularly relevant to liaison psychiatry services and mental health services accepting referrals from general hospitals and emergency departments.
In collaboration with other healthcare organisations, the Royal College of Psychiatrists has established quality standards for liaison psychiatry services as part of the Psychiatric Liaison Accreditation Network (PLAN) (Royal College of Psychiatrists, 2009). Timeliness of response to referrals is one quality indicator. This audit informed the setting of the PLAN response time standards.
The audit standards were developed following agreement by members of the liaison psychiatry service about what would constitute clinically appropriate response times to referrals. This discussion was informed by the 4-hour attendance time target set for emergency departments by the Department of Health for England (Department of Health, 1999). This led to a focus on factors that might unnecessarily delay the management of patients in an emergency department. One such factor is the response time of specialist services to referrals made by emergency department staff.
Following discussion with referrers, referrals were categorised according to the urgency of response required. The standards set for the audit were the maximum response times agreed for each category:
ᐅ emergency referrals (including all referrals from the emergency department) to be assessed within 1 hour
ᐅ urgent referrals to be assessed on the same working day
ᐅ routine referrals to be assessed within 2 working days.
The time of referral and the response time by the liaison psychiatry service were recorded for all referrals over a 3-month period. These data were collected by adaptation of the service's pre-existing referral form. In addition to the response time, data were collected on the source of the referral, the primary reason for the referral and the urgency of the referral.
The percentage of patients achieving the standard, and the mean response time and standard deviation, were calculated for each category.
This audit requires participation by all service members who accept and assess new referrals, in order to ensure that the necessary data are recorded. The audit itself can be conducted by a single person.
The audit should be conducted over a period that allows a sufficient representative sample of referrals to be obtained (e.g. 3 months). It is estimated that data collection would take 10–15 hours.