Specialist Outpatient Services Access Policy

Specialist Outpatient Services Access Policy

This policy should be read in conjunction with the Specialist Outpatient Services Access Policy (2014) and Central Referral Service Policy (2014).  This policy applies to all Western Australian public hospitals where specialist medical and surgical outpatient services are provided.

Principles

• Timeliness of care through appropriate clinical prioritisation of patient referrals
• Active management of specialist appointments
• Equitable access by providing care in the most appropriate setting to address the patient’s clinical needs
• Safety and quality measures by integrating and promoting flexibility and evidence based models of care
• Sustainability through the development of effective discharge processes to improve patient flow.

Clinical Prioritisation

The prioritisation of outpatients’ appointments is to be based on an individual patient’s clinical need, with an emphasis on timely access to care. Clinicians performing triage should allocate received referrals with one of the following urgency category criterion:

• Urgent
• Semi-Urgent
• Routine

The urgency categorisation is determined by the triaging Medical Specialist.

Business Rules

The business rules are as follows:

1.    Outpatient Visits Classification: Appointments shall be classified as New or Follow up. With the first attended visit for any referral being a New visit and all subsequent visits for the same condition being as Follow up.

2.    Review by a Specialist: Patients attending for a third follow up appointment shall be scheduled to see the treating Specialist.  A Registrar may see a patient for two consecutive follow-ups.  The fourth appointment with a doctor must be with the treating specialist or otherwise the patient should be discharged from the clinic.

3.    Active Life of Referral:

a)  Referrals issued by a General Practitioner (GP) to a Specialist remain valid for a single course of treatment or for a period of 12 months from initial specialist outpatient consultation, whichever is lesser.  GPs can indicate a shorter, longer or indefinite life of referral.

b)  Referrals issued by a Specialist to a Specialist remain valid for a single course of treatment or for 3 months from initial consultation, whichever is lesser.  These referrals (including referrals from specialist rooms, emergency departments and other outpatient clinics) may only be made for clinical conditions requiring urgent review.

c)  In all other circumstances the patient should be returned to the care of their GP with advice as to the type of specialist referral required.

d)  Where a Specialist believes an internal referral is essential, despite not being urgent, then representation should be made using the referral indicating the acuity of the clinical condition and this should be signed by the Specialist and not by a Registrar.

e) Referral for chronic conditions beyond three or twelve months require the referring practitioner to detail the patient’s clinical condition and indicate that ongoing management by a Specialist is required.

Discharge Planning/Clinical Handover

Discharge planning considers the patient’s ongoing care needs and is undertaken in consultation with the patient (and carer/guardian). Discharge Planning aims to identify issues relevant to each patient’s discharge back to the referring practitioner and/or community to initiate action to address these issues so that discharge is not delayed. Health services may exercise discretion for cases with chronic conditions for ongoing management.

Health services should develop and document guidelines/criteria to assist in identifying the point at which the episode of care is complete, so as to expedite discharge from the specialist outpatient service. Refer WA Clinical Handover Policy (2013), Appendixes D and F. The discharge process/clinical handover of a patient from the specialist outpatient services should ensure the discharge summary is communicated to:

• the patient’s General Practitioner or referrer and/or other relevant service providers for ongoing, follow-up plans, assigning responsibilities
• the Patient /Carer and they have a good understanding of the condition and are encouraged to take responsibility for managing their own health in partnership with their GP, referrer and/or other relevant service providers.

This policy is to be implemented as of 2 June 2014.

Professor Bryant Stokes
A/DIRECTOR GENERAL
DEPARTMENT OF HEALTH WA