Neobook — clinical reference

If you are the doctor referring to a higher level of care

If you are the doctor receiving the referral

The transfer of a patient is the most dangerous and vulnerable time of their medical management. Do this properly. Do not deny patient appropriate care or be an antagonistic “blocking” doctor.

If you are the doctor referring to a higher level of care

Elective referrals to OPD clinics:
ask the admin clerk to make a booking and find out when the appointment is.
write clear and thorough referral notes with the reason for the referral.
send all relevant investigation and results.
give the patient CLEAR instructions of where and when to go.
If the delay to consultation is unacceptably long:
PHONE a doctor in the relevant unit and discuss the urgency of the case, to bypass administrative obstruction. This will almost always resolve the problem.

Emergency Referrals

Identify the registrar/ MO on call and discuss the case in person fully.
Be truthful, have all the facts of the case at your disposal, know the patient.
Be clear as to why you are referring the case and what your problems are in continuing management in your institution.
Record in the notes who you have spoken to, their contact details, and the time and date of referral.
Document exactly where (which ward/ EU/ ICU etc) the patient is meant to be transferred to.
Write a clear, concise and helpful referral note with all relevant clinical information, medications, lab results and radiology images. In surgical cases you must include a copy of the operation note and the name and unit of the doctor accepting the patient.
Inform your nursing staff of the plan.
Inform the patient’s next of kin.
Contact the ambulance services.
CONTINUE THE MANAGEMENT OF THE PATIENT UNTIL THE AMBULANCE ARRIVES. It may take hours before the patient actually leaves your hospital.
If at any stage you meet unreasonable obstruction from a colleague at another institution, ESCALATE the matter to their senior consultant, Head of Unit, Head of Department or Hospital CEO until the matter is resolved. Do not accept poor service on behalf of your patient.

If you are the doctor receiving the referral

Be mindful that colleagues in peripheral/ smaller hospitals have inferior services and support, and are often clinically out of their depth. They may lack the skills to deal with what would be a simple problem in your institution.
Always BE HELPFUL, not obstructive.
If in doubt ACCEPT the referral.
Be clear as to where the patient must be sent and what pre transfer management must occur.
In principle sick, unstable, complex patients must be transferred to the Emergency Unit, and stable semi-elective cases may go directly to the ward.
Inform the receiving unit/ ward of the patient’s expected arrival.
Document the referring doctor’s name and number.
If you do not accept the referral, be clear as to the reasons, and be helpful in suggestive more appropriate care to the referring colleague.
Write notes about this decision, and mention it to your consultant at the next opportunity.