Objective: The aim of this study was to increase the proportion of appropriate referrals to 70% using an online banner. A secondary objective was to assess and increase the Parkinson disease nurse specialists’ (PDNSs’) satisfaction with the types of referrals they receive.

Background: In the East Kent Hospitals University Trust in the United Kingdom, there are five PDNSs who look after approximately over 1400 Parkinson’s patients(1). The team receives many referrals, many of which are considered inappropriate as they are beyond the PDNS team’s capabilities. One way to reduce the burden of stress seen in the department would be to further streamline the referral process to deter inappropriate referrals sent to the PDNS service to sift through and reply with rejections/further queries. 

Method: A quality improvement project was developed involving two Plan, Do, Study, Act Cycles (PDSAs) to firstly implement an online banner clinicians see before submitting a referral request and then modifying it to better serve its purpose. Concurrently, a preliminary questionnaire was sent to the PDNS to assess their satisfaction on the proportion of appropriate referrals, followed by subsequent surveys after each cycle to assess any improvements.

Results: Retrospective data (June–Oct 2023) highlighted only 37.5% of appropriate referrals. After implementing the banner in the first PDSA (November–December 2023), 80% of referrals were appropriate (P<0.01). The second PDSA (January–February 2024) saw 77% of appropriate referrals (P<0.05). Run charts were devised to track data and identify signals. Satisfaction regarding the proportion of appropriate referrals amongst the PDNS increased after PDSA 1 and maintained after PDSA 2.

Conclusion: To conclude, implementing the banner has been effective in improving the proportion of appropriate referrals to the PDNS, having met our goal of 70%. Increased awareness of the key roles of the PDNS, facilitating smoother referrals and enhancing patient care and safety by reducing unnecessary delays in the referral process were achieved.

Figure 1: PDSA Cycles for the QIP

Figure 2: Banners seen by clinician

Figure 3a: Run chart of appropriate referrals

Figure 3b: Figure 5a with runs circled red

Figure 3c: Figure 5a with shift circled blue

Table 1: Satisfaction questionnaire responses

References: (1) Patient and Service Audit at East Kent Hospitals… | Neurology Academy [Internet]. [cited 2024 Feb 21]. Available from: https://neurologyacademy.org/parkinsons-academy/projects/patient-and-service-audit-at-east-kent-hospitals-university-nhs-foundation-trust-as-part-of-parkinsons-uk-2019-national-audit

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MDS Abstracts - https://www.mdsabstracts.org/abstract/quality-improvement-of-careflow-referrals-to-parkinsons-disease-nurse-specialist-pdns-service-at-east-kent-hospitals-university-foundation-trust-ekhuft/