Quality statement 7: Referral to tertiary care

Quality statement

Adults who meet the criteria for referral to a tertiary care specialist are seen within 4 weeks of referral.

Rationale

Tertiary referrals can be vital for a number of reasons such as diagnostic uncertainty, specialised advice on drugs, surgery, epilepsy combined with other complicated medical conditions or psychological problems. Timely and appropriate access to tertiary services remains variable across the country.

Quality measure

Structure: Evidence of local arrangements for adults who meet the criteria for referral to a tertiary care specialist to be seen within 4 weeks of referral.

Process: Proportion of adults who meet the criteria for referral to a tertiary care specialist who are seen within 4 weeks of referral.

Numerator – the number of people in the denominator who are seen within 4 weeks of referral.

Denominator – the number of adults who meet the criteria for referral to a tertiary care specialist.

Outcome: Patient satisfaction with referral to a tertiary care specialist.

What the quality statement means for each audience

Service providers ensure systems are in place for adults who meet the criteria for referral to a tertiary care specialist to be seen within 4 weeks of referral.

Healthcare professionals ensure that adults who meet the criteria for referral to a tertiary care specialist are seen within 4 weeks of referral.

Commissioners ensure they commission services for adults who meet the criteria for referral to a tertiary care specialist to be seen within 4 weeks of referral.

Adults who meet the criteria for referral to a tertiary care specialist (someone who works as part of a specialist centre with a team of healthcare professionals experienced in assessing epilepsy that is hard to treat or complicated) are seen within 4 weeks of referral.

Source guidance

NICE clinical guideline 137 recommendation 1.10.2.

Data source

Structure: Local data collection.

Process: Local data collection.

Outcome: Local data collection.

Definitions

NICE clinical guideline 137 recommends that referral to tertiary services should be considered when one or more of the following criteria are present:

  • The epilepsy is not controlled with medication within 2 years of onset.

  • Management is unsuccessful after 2 drugs.

  • The adult experiences, or is at risk of, unacceptable side effects from medication.

  • There is a unilateral structural lesion.

  • There is psychological or psychiatric comorbidity.

  • There is diagnostic doubt as to the nature of the seizures or the seizure syndrome.

A tertiary care specialist in epilepsy is an adult or paediatric neurologist who devotes the majority of their working time to epilepsy, is working in a multidisciplinary tertiary referral centre with appropriate diagnostic and therapeutic resources, and is subject to regular peer review.