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The purpose of this article to study referrals to our hand service to find out how long they had been waiting and with what sort of clinical conditions. The Department of Health monitors outpatient's waiting time as the percentage of patients seen within a 13‐week target. This target does not include patients referred by consultants or other health professionals.

All the referral letters from other consultants or healthcare professionals still awaiting appointments were collected. The referrals were read and studied to ascertain the most likely diagnosis. This was recorded along with the source of the referral and the details to whom the referral was made. The date of the referral letter being received by the department (date stamped) was also noted.

A total of 157 referrals from consultants or healthcare professionals were waiting outpatient dates. The median waiting time was 448 days (range 20‐952 days). The most frequent source of referrals was from the orthopaedic department. Carpal tunnel syndrome was the most common problem awaiting an outpatient appointment.

The wait for a clinic appointment for these patients is long. This has come about as the result of the fact that the government targets for outpatient waiting times have been set for GP referrals alone and exclude referrals that have been made by other consultants or other healthcare professionals. This is a clinical governance issue for the Hospital Trust, the Primary Care Trust and for general practitioners.

The Leeds Autism Diagnostic Service (LADS) is an all IQ service accepting professional and self-referrals, from age 18, for diagnostic assessment. LADS is unusual compared to other diagnostic services in England, in that it accepts self-referrals. The purpose of this paper is to compare diagnostic outcome between self-referrals and other referral sources.

This is a service evaluation of all 692 referrals for diagnostic assessment into LADS, over a three year period, from 2016 to 2018. The diagnostic outcomes were compared between self-referrals and other referral sources. Secondary analysis looked at age and gender differences between these groups.

There were 98 self-referrals over three years with autism diagnosed in 65 per cent. In total, 594 other referrals were received during this time period, with autism diagnosed in 44 per cent. This showed a significant difference of 21 per cent with 95% confidence intervals of 10–31 per cent (p=0.0001) using a n−1 χ² test. In total, 59 per cent of self-referrals were from patients identifying as female, which compared to 35 per cent identifying as female from other referrals. This was a difference of 24 per cent with 95% confidence interval of 14–34 per cent (p<0.0001) on the n−1 χ² test.

Factors which may influence the ability to generalise from these results are: that LADS covers a large mainly urban and suburban area with a range of ethnic and socioeconomic diversity; that LADS is an all IQ service unlike some other autism diagnostic services; historical and service-related factors unique to Leeds may be dissimilar to other locations. It was beyond the scope of this evaluation to perform a qualitative analysis to compare the referral sources, but this may be an area for further study.

This evaluation supports the use of a self-referral route for adult autism diagnostic services on a local level and may support its use more widely in other services.

This evaluation, in demonstrating proportionately significantly higher autism diagnosis from self-referrals is likely to be reducing the work load of professionals who would normally make referrals. Alternatively, it may be capturing a subgroup of the autism population who would not otherwise have sought diagnosis. In either scenario, it supports and is consistent with a patient centred approach to accessing appropriate diagnostic services.

The authors are not aware that any previous evaluation of this nature has been conducted and feel this evaluation supports the use of a self-referral pathway in adult autism diagnostic services.

A referral channel is a special type of information channel, one that is missing in standard discussions of the promotional mix. In a referral channel, one firm is in a position to give information about another firm′s products to potential customers of the latter. Qualitatively different types of referral channel exist and must be managed by different forms of co‐operative strategy. Points out the significance of referral channels to a firm′s environmental analysis and business‐unit strategic planning.

People with an intellectual disability are at an increased risk of developing a mental illness. An estimated 50 per cent develop a significant psychiatric problem at some point in their lives. Since the shifting trend to treat and manage individuals in the community setting, there are concerns over the lack of guidance of how intellectual disability mental health services in the community should be organised. This paper aims to address this issue.

Details of all new referrals made to the mental health of intellectual disability team in Dartford, Kent over a 12‐month period were collated and a questionnaire was used to gather retrospective data of each referral pathway.

There were 50 patients referred in total, with the primary source being GPs (58 per cent). In total, 40 per cent of all referrals were considered to be inappropriate for the mental health of intellectual disability team and the majority of these originated from the adult mental health and child and adolescent mental health service teams.

These findings identify areas of focus for closer liaison with colleagues to improve the quality of referrals and to reduce the demands placed on our service.

Lengthy and complex routes to specialist care may negatively affect clinical profiles of trauma survivors accessing mental health services. The purpose of this study was to describe the characteristics and referral pathways of a cohort of clients accepted by a specialist trauma service in England; and investigate the associations between referral pathways and clients’ clinical profiles, namely, pre-treatment levels of post-traumatic stress, depression, anxiety, stress and post-traumatic growth.

Data on 117 consecutive, accepted referrals were extracted from clients’ clinical records. Information on demographics, trauma histories, clinical presentations and referral pathways was synthesised through summary statistics. Correlational analyses were conducted to test associations with pre-treatment scores.

Clients accessing the service were highly complex and mostly experienced prolonged, interpersonal trauma. Pathways to the service varied, but 50% of the sample had at least four “steps” in their referral histories and seven previous clinical contacts. The average time between trauma and specialist referral was 16.34 years. The number of referral steps positively, significatively and moderately correlated with anxiety and stress at pre-treatment.

Limitations include issues around collecting past referral information, the small sample size for clients with available pre-treatment data and the lack of post-treatment scores.

This evaluation provides an informative overview of the characteristics and referral pathways of clients accessing a specialist trauma service. It also offers preliminary insights on the relationship between clients’ routes into the service and their clinical profiles. Practice, commissioning and research implications are discussed.

The purpose of this paper is to investigate how referral reward programs (RRPs) utilizing scarcity messages influence bank credit holders’ referrals to and adoptions by close or distant friends.

A 2×2 experiment is implemented with 760 consumers solicited through Amazon’s Mechanical Turk worker panel. Logit transformation and general linear models are used to test the proposed hypotheses.

Results showed that offering RRPs with limited available referrals (quantity scarcity) increases the overall number of referrals to and adoptions by close and distant friends. The percent of strong ties also increases with RRPs. As quantity scarcity is relaxed, the percentages of referrals to and adoptions by close friends decrease.

The inclusion of tie strength with scarcity framing greatly enhances our understanding of the effectiveness of RRPs for bank credit cards. To the authors’ knowledge, this is the first research attempt on this topic.

Presents the results of a study which investigated whether the quality of information provided by GP referral letters to a community mental health team (CMHT) was sufficient to determine an appropriate response and the allocation of professional resources. A random sample of GP referral letters received over a six‐month period was analysed. The presenting problem, diagnosis and the indication of severity of symptoms were rated. Perusal of the CMHT members’ replies to the GPs allowed a rough analysis of the extent of agreement with the GPs’ diagnoses, description of presenting problems and severity of symptoms. Discusses the results of the study with regard to the implications of GP fundholding and the employment of GP‐based counsellors.

This paper aims to identify more advanced criteria for identifying referral opportunities and improve understanding of when to refer through developing and defining distinct question categories and related criteria.

Chat transcripts were analyzed and coded using a rubric developed on the basis of published research and original criteria developed for the study. Coding focused on whether a referral was made, if an opportunity was missed (termed “referral gap”), and what factors influenced its presence or absence.

Quantitative and qualitative factors that influence when referrals are successfully made were identified. Questions higher on the reference effort assessment data scale and those relating to subject-based research tended to have a higher referral gap, while the presence of instruction in evaluating resources had a positive impact on referrals being made. Recognizing patron-based factors such as knowledge of library policies also impacted the presence of referrals.

Limitations include the data, which were taken from a single institution and primarily reflect questions occurring in academic libraries.

Suggestions are provided for training and reference management approaches to improve the presence, substance and quality of referrals.

The study introduces a new measure for evaluating referrals, termed the “referral gap.” The methodology also expands on traditional data points used to measure when referrals should occur, which typically focus on patron and staff affiliations.

The purpose of this paper is to address a critical problem for health-care organizations: patient referral leakage. This paper explores the nature of patient referrals by examining how health-care providers’ breadth and depth of connectivity within a hospital network and identification with each other influence the likelihood of future patient referrals.

The data was collected by using a multi-sourced data set from the health-care industry. The proposed model was tested by using logistic regression to determine the likelihood of a primary care physician’s (PCP) referral to a specialist within a hospital network.

A model linking provider connectivity to examine co-creation practices in the form of patient referrals is tested. Results indicate that patient referrals are multidimensional. A PCP’s likelihood to refer to a specialist within the hospital network is influenced by the breadth and depth of connectivity of each provider.

This investigation extends service ecosystems to patients, health-care providers and hospital organizations, making it the first to explore how different degrees of connectivity (breadth of referral partners and depth of exchange) between and among health-care providers influence the likelihood of future patient referrals. Findings complement extant literature on service ecosystems by empirically showing that provider relationships are interdependent and rely on the mutual coordination of benefits within the entire health-care organization and network.

Managers and health-care professionals can use the framework to build and strengthen relational ties/alliances within a service organization. An ecosystems perspective reduces patient referral leakage through enhanced organizational performance, competitive advantage and continuity of care.

The authors offer a novel view of referral relationships using hard-to-access proprietary data. Moreover, this study responds to the need for transformative service research by offering service researchers and policymakers a means to enhance consumer well-being. The main contribution of this study is a framework to gain a better understanding of patient referral relationships between employees (i.e., health-care providers) in an organization, thereby affording an opportunity to bolster operational efficiencies, improve clinical outcomes and strengthen referral pathways. By viewing health-care networks through a service ecosystems perspective, contextual boundaries and the relative power of relationships are also identified. The novel use of rarely available hospital data in this setting helps explain how patient leakage compromises the health of the ecosystem and its members.

A significant subset of patients (12 per cent) with triple negative breast cancer (TNBC) is BRCA mutation carriers, which can be identified through genetic testing. The purpose of this paper is to evaluate the referral practice for TNBC patients with reference to New South Wales (NSW) referral guidelines at the time of diagnosis and to assess the effectiveness of such guidelines in identifying BRCA mutations. Robust health governance requires monitoring of adherence to evidence-based guidelines such as those that underpin referral for cancer genetic testing in this clinical scenario.

The authors conducted a retrospective clinical audit of identified TNBC patients at St Vincent’s Hospital (SVH) between 2006 and 2016 in NSW, comparing referral practice to guidelines extant at the time of diagnosis. Family history was considered for age guideline-inappropriate referrals to SVH while the results of BRCA gene testing were assessed for all referred.

Overall, of the 17 patients eligible for referral based on the age criterion, 10 (58.5 per cent) were referred appropriately; however, there were substantial improvements from 2012 with 100 per cent referred. Of note, 12 (33.4 per cent) of 36 patients referred to SVH were referred outside of guidelines, pointing to other reasons for referral, such as patient age (OR 0.945; 95% CI 0.914–0.978) and calendar year (OR: 1.332; 95% CI: 1.127–1.575) at TNBC diagnosis. Referral guidelines captured 66.67 per cent of identified deleterious BRCA mutations in those tested.

Substantial under-referral of guideline-eligible patients was identified, with evidence-based guidelines effective in identifying high-risk individuals for BRCA mutation testing. There was, however, a substantial proportion of guideline-inappropriate referrals.