Referral process
Step one: review of referral
When the referral is received by the relevant clinic, staff will check it is complete. Referrals that are incomplete, or do not have the required information to properly assess the referral, will not be accepted. The referring clinician will be notified in writing within eight working days of the referral being received.
The clinic will send an acknowledgement of referral receipt within eight working days, which will let you know:
- if the service is available through Mercy Health
- if the referral has been accepted and an appointment has been arranged with the appropriate service
- anticipated wait time for an appointment if none are immediately available
- if the referral has not been accepted because the patient’s condition does not meet the statewide referral criteria.
Step two: prioritising the referral
Referrals to Mercy Health non-admitted specialist services (outpatient clinics) are assessed against the statewide referral criteria or, in their absence, local clinical criteria.
Referrals to services where statewide referral criteria exist, but do not meet these criteria, will be declined.
Statewide Referral Criteria for Specialist Clinics - Victoria
- Website: Statewide Referral Criteria
-
About:
The Department of Health and Human Services has developed statewide referral criteria to assist GPs and clinicians referring patients to specialist clinics. These referral criteria have been developed to improve access to specialist clinics in public hospitals by improving the quality and appropriateness of referrals.
Referrals to outpatient clinics at Mercy Health are triaged using the clinical information and investigations provided in your referral. The referral is triaged by the specialist areas according to clinical urgency. and this determines how long the patient will have to wait for an appointment.
Referrals that do not meet the required clinical information and investigations for the service or clinics will not be accepted. Please refer to HealthPathways Melbourne for guidance with the content of your referral.
HealthPathways Melbourne
- Email address: [email protected]
- Website: HealthPathways Melbourne
-
About:
HealthPathways Melbourne provides clinicians with a single website to access clinical and referral pathways, and resources. Pathways are created by local GPs, working in partnership with specialists, nurses, allied health and other health professionals.
Mercy Health recommends clinicians to access HealthPathways Melbourne for guidance in assessing, managing and referring for patient conditions (login required).
Referrals to outpatient clinics at Mercy Health will be triaged against clinical information and investigations based on these guidelines.
Referrals that do not meet the required clinical information and investigations will not be accepted.
HealthPathways Melbourne is available for free to health professionals working in the North Western Melbourne and Eastern Melbourne Primary Health Network catchments.
Email HealthPathways to request access or if you need to confirm your username and password.
Step 3: scheduling and waitlists
Patients with high-priority access conditions are scheduled to be seen within 30 days.
Patients with non-urgent or routine conditions are given the next available appointment according to clinical need. Where an appointment is not yet available, the patient will be placed on the waitlist and seen in turn.
Both the referrer and patient are notified.
Incomplete referrals
Referrals that are incomplete or do not have the required information to assess the referral will not be accepted.
Referrals that do not meet the required clinical information and investigations for the service or clinics will not be accepted. Please refer to HealthPathways Melbourne for guidance on the content of your referral.
Mercy Health will notify the referring clinician in writing of this decision within eight working days of the referral being received.
Where a referral is incomplete but high-priority, Mercy Health will attempt to contact the referrer by telephone for the remaining information.
If we need more information, we will contact the referring clinician requesting an updated referral to be received within 30 days. If an updated referral is not sent, the referral is declined. Both the referrer and patient will notified.
Clinical prioritisation
Clinical prioritisation is the process of assigning a referral to an access category (high priority access or routine priority access) based on:
- the patient’s clinical need and related psychosocial factors
- whether or not the patient is part of a vulnerable population
- whether or not the patient has been previously discharged from the same service for the same presenting problem.
Referrals to outpatient clinics at Mercy Health are triaged using the clinical information and investigations provided in your referral. The referral is prioritised by the specialist areas according to clinical urgency. This determines how long the patient will have to wait for an appointment.
Referrals are categorised as high priority access if the patient has a condition that has the potential to deteriorate quickly with significant consequences for health and quality of life if not managed promptly.
Referrals are categorised as routine priority access if the patient’s condition is unlikely to deteriorate quickly or have significant consequences to the person’s health and quality of life if the service is delayed beyond 30 calendar days.
Waiting list
Patients are added to the specialty waiting list if an appointment is not yet available. Both the patient and referrer are notified that they have been placed on a list of waiting patients.
Administrative audits of waiting lists are regularly conducted. The patient is contacted to confirm:
- that the service is still required (e.g. the patient has not already received the service elsewhere)
- the patient’s ability to attend when an appointment becomes available
- current contact details and preferred method of communication.
Clinical audits of waiting lists are regularly conducted. This involves a clinician contacting the patient, or the patient’s referring clinician, or both, to determine:
- that the service is still required (e.g. the patient is not declining treatment)
- if there is any change in the patient’s clinical condition, or if there should be a change to the patient’s clinical prioritisation
- if there is any reason why the patient should be removed from the list of waiting patients
Health services may remove a patient from a list of patients waiting for an appointment if the patient:
- no longer requires or consents to the service. This can be because they have, or plan to, receive the service elsewhere
- their presenting problem has resolved
- they are declining treatment
- has not accessed the tests or investigations that must be completed prior to the appointment on two consecutive occasions
- has not responded to two invitations to make an appointment or
- has not attended an appointment on two consecutive occasions
- is ‘not ready for care’.
The referring clinician is contacted before a decision based on the patient not responding or attending is finalised.
Resources
Statewide Referral Criteria for Specialist Clinics - Victoria
- Website: Statewide Referral Criteria
-
About:
The Department of Health and Human Services has developed statewide referral criteria to assist GPs and clinicians referring patients to specialist clinics. These referral criteria have been developed to improve access to specialist clinics in public hospitals by improving the quality and appropriateness of referrals.
HealthPathways Melbourne
- Email address: [email protected]
- Website: HealthPathways Melbourne
-
About:
HealthPathways Melbourne provides clinicians with a single website to access clinical and referral pathways, and resources. Pathways are created by local GPs, working in partnership with specialists, nurses, allied health and other health professionals.
Mercy Health recommends clinicians to access HealthPathways Melbourne for guidance in assessing, managing and referring for patient conditions (login required).
Referrals to outpatient clinics at Mercy Health will be triaged against clinical information and investigations based on these guidelines.
Referrals that do not meet the required clinical information and investigations will not be accepted.
HealthPathways Melbourne is available for free to health professionals working in the North Western Melbourne and Eastern Melbourne Primary Health Network catchments.
Email HealthPathways to request access or if you need to confirm your username and password.
The Managing referrals to non-admitted specialist services in Victorian public health services policy
- Website: Access policy
-
About:
The Managing referrals to non-admitted specialist services in Victorian public health services policy outlines the government’s expectations of service delivery, including indicative timeframes for the implementation of key processes relating to specialist clinics.
Last reviewed October 30, 2019.