Lighting the way: the LANTERN system for children’s autism referrals to enhance triage effectiveness and navigate frontline timely support

Abstract

Objectives: To evaluate the implementation and outcomes of the Layered Assessment of Neurodevelopmental Needs, Evaluation of Referrals and Navigation of support (LANTERN) triage system developed to improve referral quality, reduce unnecessary delays and enhance support for children referred for autism diagnostic assessment. Design: Service improvement informed by action-based methodology and clinical audit, employing descriptive analysis of administrative and outcome data. Setting: A UK National Health Service community paediatric service covering 59 000 children aged 4–16. Participants: All referrals to the neurodevelopmental pathway for autism assessment from April 2019 to March 2025. Intervention: The LANTERN system incorporates senior diagnostician-led triage, expanded evidence review and detailed guidance for families and referrers. Main outcome measures: Referral volume and acceptance rates, rates per 1000 population, patient experience via friends and family test and cost-effectiveness. Results: Referral rates fell 25% over 5 years, and acceptance rates dropped from 79.6% (2019–2020) to 61% (2024–2025), compared with 92% in the wider region. LANTERN achieved a local referral rate of 4 per 1000 versus 33 system-wide. ‘Good’ or ‘very good’ family satisfaction rose from 35% to 95%. The system incurred an annual cost of £58 695 but avoided £96 025 in assessments not indicated, yielding a net saving of ~£37 330. Conclusions: The LANTERN system reduced assessments not indicated while improving family satisfaction and support for children, families and referrers. A senior-led, evidence-informed triage can enhance quality and efficiency in the autism diagnostic pathway.