|Title:||Specialist Outpatient Services Access Policy|
|Document ID:||Operational Directive OD 0530/14|
|Date of issue:||Wednesday, 18 June 2014|
|Description:||The Operational Directive from the Director General is to advise all Area Health Services that an update of the Specialist Outpatient Services Access Policy has now been completed and should be adhered to from the date of the Operational Directive. The Specialist Outpatient Services Access Policy is the single document to guide Health Services in the delivery and management for specialist outpatient appointments, with an emphasis on discharging patients from specialist outpatient services to their primary health care providers.|
|Applicable to:||All Area Health Service and Department of Health staff who are involved in both a clinical and administrative capacity in the delivery of specialist outpatient appointments.|
|Framework:||Clinical Services Planning and Programs Policy Framework|
|Period of effect:||from 2 June 2014 to 2 June 2014|
|Review date:||2 June 2019|
|Authorised by:||Professor Bryant Stokes, A/Director General, Department of Health WA, 30-May-2014|
|Print version:||View print version|
Specialist Outpatient Services Access Policy
This Operational Directive 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. This directive supersedes 0359/12. However, the business rules from 0359/12 remain in effect.
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:
The urgency categorisation is determined by the triaging Medical Specialist.
The business rules outlined in OD 0125/08 remain current. These rules are as following:
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:
This Operational Directive is to be implemented as from 2 June 2014.
Professor Bryant Stokes
This circular last updated: Thursday, 19 June 2014 at 3:55pm