Every referral received, triaged by a clinician and acknowledged within a working day

Where referrals are lost

In an analysis of 103,737 referral scheduling attempts from a large US primary care network to 20 high-volume specialties in 2015 and 2016, only 34.8% resulted in a documented completed appointment.¹ 38.9% of the attempts had no appointment date at all, and wait times and distance explained much of the rest.¹

In a 2008 national survey of 4,720 US physicians, 69.3% of primary care physicians said they always or mostly send the patient's history and reason for referral, while only 34.8% of specialists said they always or mostly receive it. Specialists reported sending results back 80.6% of the time, and 62.2% of primary care physicians said they received them.²

In a 2024 survey of 8,122 US family physicians, only 19% reported an ideal experience with encounter documents, meaning the information arrived automatically and was easy to find and reconcile.³ More on why the letter carries the clinical work is in the referral letter.

Intake in the first hour

Match every referral, whether it arrives by email, letter, fax or portal, to an existing patient or a new record, file it there and check it against the completeness list below.

A complete referral carries the patient's identity and contact details, the referrer, the question being asked, relevant history, medications and allergies, recent results and the urgency the referrer expects. Request anything missing from the referrer the same day, in one message that lists every gap.

In England, Regulation 12 asks providers to work with others where responsibility for a patient's care is shared or transferred, so that timely care planning takes place.⁴ Record who filed each referral and when.

Triage belongs to a clinician

The clinician sets the urgency, chooses the right clinician and appointment type, and decides whether any tests should happen before the visit.

The referral reaches the clinician already matched to the record, with gaps requested and history summarised, so the decision takes minutes. Fix two triage slots a day and no referral waits more than half a working day.

A referral marked urgent, or one that describes red flags, goes to the duty clinician at once, whatever the time.

Acknowledging the referrer and the patient

Send two messages within one working day. The referrer hears that the referral arrived, who will see the patient and when. The patient hears from the clinic before they think to call, with a time or the date by which one will be offered.

To the referrer. "Thank you for referring your patient to us. We received the referral today, and Dr Lim will see them within two weeks. We will write to you after the appointment."

To the patient. "Your doctor has asked us to see you. We have an appointment for you on Tuesday at 09:30, or you can choose another time with the link below. Please bring a list of your current medications."

wai Admin drafts each acknowledgement inside the patient's thread, and the team approves it before it sends.⁵ After the visit, wai drafts the letter back to the referrer from the consultation, and the treating clinician checks and signs it.⁶ Each draft is logged with its approval and signature.⁷

Every other document follows the same path

Discharge letters, outside results and reports from other clinicians take the same route as a referral. Each is matched, filed and routed to the clinician who needs it, with a named reader and a decision recorded. Outside results then join the clinic's own results list, covered in our guide to recalls and results administration.

Where to start

Take last month's referrals and record, for each, the time to acknowledgement, the time to triage, the time to first appointment and whether a letter went back to the referrer.

Adopt the standards in the table below, write the two acknowledgement templates and fix the two daily triage slots. After a month, measure the same four times again, with the share of referrals that arrived complete.

Frequently asked questions