BACKGROUND:
Timely access to memory assessment is essential for accurate diagnosis and early intervention. Local Dementia Strategy recommends a maximum Referral to Treatment Time (RTT) of 18 weeks. However, the audit revealed an average RTT of 46 weeks, with significant delays for paper referrals and indirect pathways alongside possible inequities.
METHODS:
Six-month retrospective audit of 80 patients at a Memory Assessment Clinic. Audit scope included new and follow-up patients seen during the study period. Inclusion criteria were all patients referred for assessment of possible dementia with both referral and first appointment dates recorded in the clinical record. Exclusions applied to cases with missing or incomplete date fields and patients registered for non-memory related assessments. Data obtained from electronic clinical portal covering – referral source, referral method, demographic characteristics and clinical diagnosis. Waiting times were calculated from recorded referral date to the first scheduled or attended appointment. Referral dates documented in clinical letters were cross checked against the official referral date recorded in the electronic portal to assess consistency. Analyses compared waiting times across demographic groups, referral pathways, and diagnostic categories to identify factors contributing to delays.
RESULTS:
Mean waiting time from referral to first appointment 46 weeks, exceeding the 18-week target.Paper referrals showed delays of up to 300 days between receipt and electronic entry to the patient tracker list, whereas electronic referrals were promptly recorded.GP referrals routed via Neurology had the longest waits (>300 days). Males waited on average 79 days longer than females. Only 25% of patients were from Black, Asian and Minority Ethnic backgrounds despite comprising 52% of the local population. Asian and Black patients experienced longer waits. Interpreter provision was inconsistent, with family members used in all non-English-speaking cases. Shortest waiting times observed in dementia subtypes characterised by distinctive presentations, such as Lewy body dementia and longest for diagnostically uncertain cases.
CONCLUSION:
Delays in memory assessment are not just clinical inefficiencies, they are equity issues. Addressing them requires systemic change, digital transformation, and culturally competent care. Implementing the proposed recommendations will support earlier diagnosis, better care planning, reduce inequalities and improved outcomes.