A clinician-led approach at Nottingham University Hospitals is using Nervecentre to make admission referrals more visible, consistent and actionable.
Managing patient flow out of a busy Emergency Department is rarely straightforward. At Nottingham University Hospitals NHS Trust (NUH), different specialties had developed different ways of managing admission referrals. Some were electronic, others relied on telephone conversations, while decisions could be documented in different parts of the patient record.
Teams could see patients waiting in ED, but they couldn’t always see why they were waiting.That lack of visibility made it harder to identify bottlenecks, intervene when referrals stalled and distinguish between patients genuinely waiting for a bed and those whose pathway could still be progressed.
NUH set out to change that.
Creating a shared approach to admission referrals
Led by Dr Joanna Varcoe, ED Consultant and clinical lead for the trust-wide Inter-Specialty Working project, more than 200 clinicians and operational colleagues helped develop a consistent approach to admission referrals.
The result was the NeT model: Navigation, E-referral and Transfer. It defines the three stages of an admission referral, the expected response times at each stage and the escalation process when those standards aren’t met.
Crucially, the work started with clinical agreement rather than technology. Once those standards had been established, NUH worked with its digital team to embed them within the trust’s Nervecentre EPR.
Making the patient journey visible
Nervecentre now gives clinical and operational teams a shared view of where each patient is within the referral process. They can see when a navigation decision has been made, whether a referral has been sent, which specialty has accepted responsibility for the patient and when that happened.
Automated time-outs monitor agreed response times, while visual prompts highlight when escalation may be required. Live operational dashboards provide further visibility of referral response times, bed waits, transfers, admissions by specialty and variation across the pathway.
Rather than relying on repeated phone calls or fragmented documentation, teams can work from the same operational picture.
As Dr Varcoe explains:
“I now have greater confidence that if a patient is waiting in ED for a bed, they are truly waiting for a bed to become available, not for specialty agreement on where they should best be placed.”
Building the foundations for further improvement
NUH is clear that no single workflow can solve the wider challenge of patient flow, but the NeT model is helping the trust establish something fundamental: visibility.
Referral response times have shown a positive trajectory, clinicians report greater confidence in understanding where patients are within their referral journey, and bed management teams have better information about which specialty has accepted responsibility for each patient.
The digital pathway is also creating a consistent data trail that can help NUH identify bottlenecks, understand variation and target future improvements.
Development continues, with clinicians and Nervecentre working together to streamline the workflow further and make it increasingly intuitive for frontline teams.
Read the full case study
The NeT model was a finalist in the 2026 HSJ Patient Safety Awards.
Download the full case study to explore how NUH developed the NeT model, built clinical consensus across more than 200 colleagues and used its Nervecentre EPR to turn agreed professional standards into a visible, measurable admission pathway.
