Effectively manage referrals
It is important for the practice to effectively manage referrals
to other health care providers/diagnostics and recalls within your
practice. This assists in promoting optimum opportunity for the
patient to receive appropriate diagnosis, care and treatment.
If you have felt it important to refer a patient to another
practitioner, then you need to be aware of the outcome of that
referral. Developing a tracking system that records referrals and
returned reports will identify any patients who do not present for
appointments with practitioners to whom they have been
A recall system can be utilised to track 'at-risk' patients who
you have asked to return for clinical review.
Improving your practice
You should explain to your patient the reason for a referral and
whether or not it is urgent. This advice should be documented in
the patient record.
Discussion of the patient's expectations of the referral outcome
and arrangements for continuity of care should also take place. As
the referring practitioner, you should include the following as a
minimum in your referral letter:
- Patient personal and contact details
- Patient occupation
- Patient social history
- Patient medical history, including current medications,
allergies, past and current medical conditions
- Relevant test results
- Reason for referral
Determine which referrals will require tracking by
- The patient's condition - is it serious or
- The risks to the patient of either delaying or not attending
the referral appointment.
- Whether diagnostic tests were abnormal.
- What steps reasonably ought to be taken in fulfilment of this
duty of care, which will depend on the magnitude of the risk of an
- How following up a specialist referral for a potentially
serious condition may reasonably be more than that for a less
serious condition (urgent referral to a cardiologist re: recent
sub-acute cardiac symptoms compared to referral to an orthopaedic
surgeon for osteoarthritis of the knee).
- Where a patient declines to attend a specialist, it is
advisable to document that you have explained to them the
consequences of non-attendance.
The system you adopt to ensure that patients are followed up
when referred should:
- Be simple enough that it does not impose an onerous task on
- Be effective enough that a patient who needs to be seen does
not slip through the system
- Be easily managed via your computer software or via manual
system (refer to attached referral tracking spread sheet).
Some of the principles discussed in the previous section on
'test tracking' will assist this process. Please also consider the
- If a referral is considered urgent, make the appointment for
the patient yourself to ensure it gets done.
- If you deem it necessary to make the appointment for the
patient, details of the appointment should be recorded in the
- Have discussions with patients on the importance/urgency of the
referral to be documented in the patient notes.
- Develop a centralised 'referral tracking' system similar to the
'test tracking' system discussed previously. This will assist in
checking correspondence has been received from the specialist or
practice to which the patient was referred. It will help to ensure
- If the reason for referral is less urgent, you can track
patients by marking them as a 'recall' for a date that you would
expect some feedback from the referral. Perhaps your computer
software could send you a reminder at the next patient
- Letters of referral to medical specialists or consultant
physicians need to comply with government regulations. (See Medicare
Benefits Schedule Book).
- Referrals for pathology or radiology tests need to comply with
government regulations. (See Medicare
Benefits Schedule Book). Contact the pathology or radiology
company for relevant referral stationery or availability of
- Procedures for referrals and recalls should be documented in
the practice's procedure manual and all staff should be
- Use a date stamp for all incoming referral letters.
Where specialists advise a referring practitioner of a patient's
failure to attend an appointment:
- Some referring practitioners will forward a referral to a
specialist before the patient has made an appointment.
- It is important to have a triage process in place to ensure a
timely appointment is provided to the patient.
- Where referrals are received but where no appointment has been
made, it should be returned to the referring practitioner after the
specialist has assessed a reasonable time has passed since receipt
- When a patient does not present for a referred appointment or
has cancelled an appointment the specialist must provide this
information to the referring practitioner to ensure continuity of
care is appropriately provided.
- If a patient refuses for the normal treating general
practitioner to be provided with feedback about a consultation,
such as the case when a patient is reviewed by a skin cancer
clinic; request the patient signs a form refusing information to be
provided to the normal general practitioner.
The operation of a recall system is straightforward once a
manual or computerised system is set up. The success of the recall
system is dependent on you flagging the patient for recall during
The mail-outs to recalled patients can be managed by the
practice manager or registered nurse who is responsible for
monitoring the patients who require recalls.
Letters are often printed on a monthly basis and reviewed and
signed by the practitioner before posting.
If you use a manual recall system, you can initiate it by
annotating a stamp on the patient file. The patient's file can then be
forwarded to the staff member responsible for monitoring the manual
recall system who records the recall for the appropriate month in a
Each month is reviewed and recall letters are printed and signed
by the practitioner before sending.
It is important to ensure that you document all attempts to
recall your patients. A copy of each letter sent should be kept on
the patient's file, including whether it was sent by registered
mail. Any telephone contact or messages left should be documented
in the patient's file with the relevant date and time of call, the
name of the person who made the call and any action taken.
It may be convenient to SMS patients who are due for recalls.
However, clinical information should not be included in the SMS.
Patients should provide consent to an SMS recall system.
Patients have the right to not partake in a recall system. The
patient's express wishes to not partake should be documented in the