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An analysis of the UK National Poisons Information Service consultant referral process

Author/s James D, Thomas S, Waugh R, Vale JA, Thompson J, Eddleston M
Year 2014
Type of publication Conference proceeding

Background: UK National Poisons Information Service (NPIS) clinical toxicologists (CTs) received 1540 referrals from specialists in poisons information (SPIs) in 2011/12. This study was performed to explore the views and experiences of the enquiry referral process for NPIS SPIs and CTs, to create awareness of the challenges faced by both parties and to explore ways of facilitating a more efficient referral process.

Methods: Anonymous, online questionnaires were used to collect the views of CTs and SPIs. Likert response scale questions were combined with a free text comments box. Responses were analysed to identify strengths and weaknesses of the current referral process, opportunities for improvement and potential barriers to change. Results were subsequently discussed with stakeholders.

Results: 42 of 43 SPIs and all 15 CTs responded (response rate 98%). Most responses indicated satisfaction with the process. Forty-seven per cent of CTs reported delays when contacting SPIs (partly due to telephone system problems), 40% that too few calls were referred (but none that too many referrals were made) and 20% that the information provided by SPIs is “only occasionally sufficient” for a clinical judgment to be made. Twenty per cent felt that SPIs relay information too quickly (but none felt delivery was too slow). Several CTs preferred to be told the reason for the referral at the start of the call, before a detailed clinical history is provided (13% in free text comments and 40% in subsequent discussion). A typical CT comment was “referrals are generally of a high quality.” For SPIs, 10% reported problems in contacting the CT, 98% responded that the CT “usually” or “always” understands the reason for the call and 21% that CTs should always offer to speak to the enquirer directly. SPIs praised consultants who email a summary of the advice that they have given, as they value the support from CTs in documenting complex calls. Use of a standardized handover tool for information delivery was supported by 53% of CTs and 52% of SPIs.

Conclusion: Whilst most responses indicated satisfaction with the process, this survey has highlighted areas for improvement, many of which can be achieved by enhanced awareness and training for both groups.

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