RACGP webinar – Effective referral letters…and why they matter

An effective referral gets the patient the care they need, when they need it and in the best place – which may not always be in hospital.

That is the key takeaway from a recent RACGP webinar featuring CALHN presenters Professor Jane Andrews, Dr Jessica Hafner, Dr Andrew Vanlint, Dr Jackie Yeoh and SA Health’s Dr Emily Kirkpatrick. 

Forty-three GP’s tuned into the webinar aimed providing an insight into the referral process at our network and improving two-way communication between GPs and hospitals.

The right care, right place, right time
“We are moving away from the ‘traditional approach’ where a patient has to be referred to outpatients before a GP is able to seek assistance, and making it easier for GPs to contact clinicians for advice,” CALHN GP Liaison Officer, Dr Jackie Yeoh, said.

“We believe that this will lead to better outcomes.

“Key to this is open communication and the development of clear clinic and referral criteria, so that when patients are referred to us, we can effectively assess and triage them – and act quickly.”

Historically, all referrals were being accepted and placed on a non-urgent waiting list. This has led to long wait lists in some areas.

“Without changing the model, the waiting lists will only continue to get longer without any guarantee of the patient eventually being seen and their problem managed and we know that this wait is not beneficial for anyone,” panellist and CALHN neurologist Dr Jessica Hafner said.

“This is an important change to a more modern approach, where we are removing barriers and enabling GPs and specialists to be able to treat patients in a team approach without the wait.”

When a referral arrives at our central outpatients area, it is registered and distributed to the receiving specialty unit. There, a decision is made on whether it is accepted, if care is to remain with GP or if the patient would be better treated in another system.

A determination is made on how urgently the patient needs to be seen, and the best person or system to expedite that care.

You can find advice on what to consider in a referral here.

“By ensuring a patient’s referral tells a clear story including things like test results, impact on quality of life and timelines, helps with triaging,” Dr Yeoh said.

“In some cases there could be better alternatives.

“It could be a public outpatient clinic appointment, accessing specialist advice to support GPs to manage a patient, advice on resources or education, or advice on referring within another system or speciality.”

“We cannot stress enough though that if the referral is urgent or if you would like to discuss your referral with a clinician to get advice before sending it, please ring the person on call for the unit to which you are referring.”

What are we doing to help streamline the process?
Across CALHN, we are developing clear referral criteria to help guide referrals and ensuring this information is easier to find on our website.

“We hope that this, combined with a more open and straightforward way for GPs to contact hospital clinicians for advice, will help streamline referrals,” Dr Yeoh said.

“Recognising that there needs to be two way communication, we are putting a greater focus on the triage reply process and are working with GPs to developing clear letters to explain why a referral has been declined.

“This includes letting GPs know what to do if a patient doesn’t meet the referral criteria and what is needed if a GP decides to re-refer.”

The work CALHN is doing is in conjunction with a Statewide outpatients reform process.

If you get stuck, check Health Pathways or the RAH website for the appropriate unit, call the on-call registrar for the appropriate unit or contact the GP Liaison Unit for advice.