Statewide referral criteria for specialist clinics

The Department of Health 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.

Statewide referral criteria improve patients’ specialist outpatient experience and ensure that:

• Patient referrals are assessed against the same criteria in all Victorian public hospital specialist clinics.
• Referral and communication processes between referrers and specialist clinics services are improved.
• Referring clinicians know when a referral to a public specialist clinic is required and the information that should be included in the referral.
• Specialist clinics have the right information on the referral documentation to assess and accept the referral.

The Department of Health undertook a program evaluation in 2022-2023 to understand the impact and outcomes of the implementation of statewide referral criteria in Victoria. The key evaluation findings include that the introduction of statewide referral criteria has achieved the intended outcomes. Data extracted from the Victorian Integrated Non-Admitted Health (VINAH) dataset show a clear downward trend in the total number of referrals received for specialities with statewide referral criteria, when compared to other specialities.

Consultation process

Clinical Review Panels for a range of speciality clinics developed the criteria. The panel membership included a multidisciplinary team of clinicians - Heads of Unit /clinicians of the speciality unit involved, General Practitioners, health service nursing and allied health clinicians and GP Liaison Officers and Primary Health Network clinical writers. The panel was chaired by an independent public health service executive.

Primary Health Networks provided information on the most common reasons for referral, based on hits to pages within HealthPathways. Each panel worked on the common reasons for referral to public hospital. Each panel then developed criteria for the most common reasons for referral to public hospitals for a specialty. The referral criteria developed represent the final consensus opinion of the clinical panel.

HealthPathways

HealthPathways is a web-based portal with evidence-based information on the assessment and management of common clinical conditions including referral guidance. HealthPathways have been designed for use during the consultation between the GP and patient.

The HealthPathways guides are written by General Practitioners in consultation with other local GPs, hospital-based specialists and subject matter experts, to provide evidence-based guidance on how to assess and manage common clinical conditions in primary health.

The Department of Health is working closely with PHNs on the development and implementation of the statewide referral criteria and their incorporation into HealthPathways.

Online clinical and referral pathways supporting the statewide referral criteria will be available to primary care practitioners across all six Victorian PHNs. Primary health practitioners can access the pathways via the Victorian and Tasmanian PHN Allliance.

Clinical Specialities implementation

Statewide Referral criteria for common conditions in the following specialties are already in use:

• Cardiology
• Chronic pain (referrals to health independence program services)
• Endocrinology
• ENT
• Gastroenterology including diagnostic endoscopies 
• Gynaecology
• Joint pain
• Long COVID
• Neurology
• Obstetrics
• Ophthalmology
• General surgery
• Respiratory
• Rheumatology
• Urology
• Vascular

Further statewide referral criteria will be developed for implementation in 2025.

Feedback

The department welcomes feedback about improvements to the referral criteria content via email to Specialist Clinics.