Specialty Referral Delay Audit

This project audits the quality, timeliness and reliability of specialty referral processes. It reviews whether referrals are made through the correct route with sufficient clinical information, are acknowledged and acted on, and whether delay contributes to diagnostic delay, treatment delay, prolonged length of stay, unsafe handover or missed escalation.

• Acute medicine, emergency medicine and general internal medicine teams
• Specialty and on-call review teams, including surgical, medical and liaison specialties
• Ward leaders, nurses, ACPs and physician associates
• Site, patient-flow and clinical operations teams
• QI leads, governance teams and educators

• Measure documentation of referral indication, specialty, urgency and route
• Assess acknowledgement, specialty review and timeliness against locally agreed timeframes
• Assess escalation, ongoing clinical ownership and handover where referrals remain outstanding
• Identify variation by clinical area / location, optional specialty / service and referred specialty
• Generate governance-ready and ARCP-ready evidence

• Anonymous case identifier
• Inclusion / eligibility decision
• Anonymised biodata (age band, recorded sex/gender, care setting, assessment context)
• Clinical area / location and optional specialty / service
• Sixteen specialty referral delay criteria (met / not met / not applicable)
• Free-text learning points and any project custom fields

• Live dashboard
• Audit report (Word)
• Executive summary (Word)
• Excel workbook
• PowerPoint presentation
• Conference poster
• ARCP evidence summary

This ready-built project is developed using the guidance, standards and authoritative sources listed below, so you can see what is being measured and why. Lazomis QI does not publish or own this guidance, and inclusion here does not imply endorsement or approval by any of these organisations.

• NHS England

  Urgent and emergency care(opens the original source in a new tab)

  National framing for acute pathways, specialty review and flow between ED, assessment units and specialty teams.

• NHS England

  Referral to treatment (RTT) waiting times(opens the original source in a new tab)

  National rules and definitions for referral-to-treatment pathways, relevant to outpatient and elective specialty referrals.

• NHS England / NHS Digital

  NHS e-Referral Service(opens the original source in a new tab)

  Guidance on electronic referral workflows, referral information standards and referral tracking.

• NHS England

  Getting It Right First Time (GIRFT)(opens the original source in a new tab)

  Specialty pathway reports relevant to referral flow, specialist review timeliness and service design.

• Designed to use anonymised or pseudonymised audit identifiers.
• This tool supports, but does not replace, clinical judgement.
• Local policy, formulary and specialist advice should be followed.
• Organisations remain responsible for local governance arrangements.
• This tool supports, but does not replace, clinical judgement. Follow local policy, referral pathways and specialist advice.
• Use anonymous case identifiers only — never patient-identifiable information.

Supporting guidance from the Lazomis QI Resource Library. Authoritative clinical standards referenced by this project remain separate.

• Service RedesignBottleneck Analysis in Healthcare: Identifying and Resolving Flow IssuesThis guide provides a practical framework for identifying and resolving bottlenecks in healthcare services, enhancing patient flow and operational efficiency within the NHS.
• Service RedesignHow to Redesign a Referral Pathway in the NHSThis article outlines a structured approach to redesigning referral pathways within the NHS, focusing on improving patient experience, efficiency, and clinical outcomes. It covers key steps from initial scoping to implementation and evaluation.
• Clinical GovernanceLeveraging Incident Themes for Quality Improvement and Patient SafetyThis guide helps NHS teams identify and analyse recurring incident themes, transforming reported safety events into practical quality improvement opportunities to enhance patient safety and system reliability.
• Patient SafetyDiagnostic Delay: Understanding and Mitigating a Critical Patient Safety RiskDiagnostic delay is a significant patient safety concern across all healthcare settings. This guide explains why timely diagnosis is crucial, details the common factors contributing to delays, and provides actionable strategies for healthcare professionals and teams to mitigate these risks.