Quality Improvement Project: Referral Process for Adults With Suspected ADHD

Abstract

Aims

Twelve GP surgeries refer adults with suspected ADHD to Horsham Assessment and Treatment Service (ATS). Patients are referred by GPs via letter and an adult ADHD self-report scale (ASRS). Letter contents are variable and some referrals are rejected. There is no gold standard or national guideline for what referral information is required. We used a combination of guidelines and advice from The Royal College of Psychiatrists, The National Institute for Health and Care Excellence, and ADHD UK. Aims: to evaluate the current quality of the referrals, to obtain GP’' views on the referral process, to make the process more efficient and clearer, and with that improve patient experience.

Methods

A retrospective data collection method was used. 57 patients were referred between 31^st August 2021 and 1^st April 2022. We reviewed 54 referral letters (3 were excluded). Main information looked for: presenting difficulties, resultant impairments, confirmation some symptoms present in childhood, past medical history, family history and if an ASRS was attached. We sent a questionnaire to obtain GPs’ opinions on the referral process and how to improve this.

Results

Results of reviewing referral letters:

• • 89% of referrals explained the current difficulties

• • 52% described the resultant impairments

• • 61% of referrals mentioned if symptoms had been present in childhood

• • 91% of referrals contained past medical history and current medication

• • No referrals mentioned family history

• • 6% of referrals contained some physical health data

• • 85% of referrals to ATS were accepted; 13% rejected as ASRS not attached.

Results from GP questionnaires: 11 surveys were returned. Most GPs were not confident in making a referral or what information is required, and did not understand the referral process. GPs would like a referral form, a flowchart outlining the referral process and information for patients about ADHD assessment.

Conclusion

89% of referrals explained current difficulties. Just over half described the resultant impairments, and confirmed if there were symptoms in childhood. Most referrals contained past medical history. 6% contained some physical health data. Only 85% of referrals were accepted. GPs would like a referral form, a flowchart and information for patients.

Results were distributed to staff in ATS and we will distribute results to GPs. We have created a referral form and flowchart to make the referral process more efficient and clearer, and to improve patient experience. We will re-evaluate this after a few weeks, so we can compare with previous data collected.