Referral: four principles and 10 steps

Br J Cardiol 2008;15:225 Leave a comment
Click any image to enlarge

When any doctor or nurse refers to a colleague they should automatically ask themselves: is this referral necessary and will it benefit the patient? Referral should never be an automatic choice and the circumstances may dictate a different option.

An extreme example is the terminally ill patient with severe central chest pain. Even if they are suffering a myocardial infarction, urgent admission may not be the best option in their care. Unnecessary referral wastes the time of both clinicians and patients. It adds to waiting times for more needy patients. Equally we could be guilty of under referral and could be providing less than perfect care for our patients.

The clinician needs to ask four principle questions before referral. First: will the referral improve the accuracy of diagnosis and provide better management of the disorder? Second: have all the appropriate examinations and investigations been carried out?

The third concerns treatment: all patients should have appropriate treatment initiated as soon as possible as delay can, in many cases, leave them exposed to harm. The fourth principle question is: am I referring this patient to the service or individual who will best help their management?

In this issue we begin a series of articles looking at the subject of appropriate referral (see pages 254–7). Each article will look at 10 key steps in answering these four principles. Do I need to refer; have I fully investigated the patient; have I initiated appropriate treatment and am I referring to the right service?

We hope this will interest not only those carrying out the referral but also the recipients of referrals. Hopefully those who agree or disagree with the authors, or feel there are omissions, will correspond with us in order to generate debate on these subjects.

Conflict of interest

None declared.