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Pitfalls and potential dangers in the referral process to a specialist brain injury unit

^*Lishman Brain Injury Unit, Maudsley Hospital, Denmark Hill, London SE5 8AZ, email: jaykuruvatti{at}hotmail.com

Simon Fleminger, Consultant Neuropsychiatrist and Honorary Senior Lecturer

Lishman Brain Injury Unit, Maudsley Hospital, London

Declaration of interest

S.F. is consultant for the Lishman Brain Injury Unit which continues to rely on funded authorised referrals.

AIMS AND METHODS

We looked retrospectively at referrals over 1 year and determined the length of time from receipt of the referral to the date when authorisation to see the patient was given, and the time from authorisation to first contact. For in-patients we determined the time from the recommendation for admission to the time authorisation was granted, and the time from authorisation to admission.

RESULTS

Of the 108 referrals, 80 (74%) were seen within 13 weeks (mean=53 days); 7 patients (6%) had to wait over 13 weeks, usually because of delays in authorisation; 10 patients were admitted; 14 were never admitted (although we had recommended admission). The time from recommendation to admit to authorisation of admission, 27 days, was the same as the time they waited for a bed once authorisation had been given.

CLINICAL IMPLICATIONS

Waiting for authorisation seemed in some patients to delay their access to tertiary services. Any advantage of using panels to authorise referrals, like ensuring better use of local resources, may be outweighed by patients taking longer to get the care that best meets their needs.