BT10 Referral bingo! Does information quality determine outcome in a universal dermatology advice and guidance pathway?

Abstract

Advice and Guidance (A&G) is increasingly used to optimize dermatology referral pathways, reducing unnecessary outpatient attendance and delayed diagnosis and treatment. National guidance from Getting It Right First Time (GIRFT) and NHS England emphasize high-quality referrals and effective triage as key components of referral optimization. However, variation in the quality of referral information may limit the effectiveness of A&G in real-world clinical practice. In our service, all non-urgent suspected cancer referrals are triaged through a universal A&G-first model. The aim of this study was to evaluate the pathway outcomes of a universal A&G-first dermatology triage model and to assess the relationship between the quality of referral information (‘referral bingo’) and successful resolution without face-to-face clinic attendance. A retrospective audit of 150 consecutive non-urgent suspected cancer referrals submitted via the NHS e-Referral Service was undertaken. Referral quality was scored against a standardized referral question quality score (0–8), derived from GIRFT dermatology recommendations and the NHS A&G delivery framework. The primary outcome was resolution via A&G, defined as management without requiring face-to-face clinic attendance. Overall, 25% of referrals (38 of 150) were resolved through A&G without a clinic appointment. Referrals resolved via A&G had higher referral question quality scores than those converted to clinic appointment (mean score 6.7 vs. 5.1). Resolution increased stepwise with referral quality: low-quality referrals (scores 0–4) were resolved in 7.5% of cases [95% confidence interval (CI) 2.6–19.9], compared with 15.2% (95% CI 8.4–25.7) for moderate-­quality referrals (scores 5–6) and 56.8% (95% CI 42.2–70.3) for high-quality referrals (scores 7–8). A universal A&G-first dermatology triage model supports timely access to specialist advice and effective management with a corresponding reduction in unnecessary outpatient attendances. Higher referral information quality is strongly associated with successful resolution through A&G, supporting referral optimization as a practical means of improving efficiency within GIRFT-aligned dermatology pathways.