Incomplete general practitioner (GP) referrals cannot be triaged effectively, impacting on quality and timeliness of patient care. A regional Integrated Cancer Service (ICS), which monitors processes to improve cancer patient experience within acute health systems, and a Primary Health Network (PHN), which has established links to general practices, aimed to develop a collaborative approach to increase colonoscopy referral quality in areas targeted for improvement.
Initially, 110 colonoscopy referrals from 43 general practices were sourced from a public hospital’s medical records. Baseline referral completeness was assessed by calculating the proportion of the 110 referrals with each item required for triaging. These results were reported to a PHN Primary Care Coordinator, who provided targeted feedback on referral quality to regional general practices through direct visits and disseminating information. Subsequently, a further random sample of 48 colonoscopy referrals was sourced. Follow-up referral completeness was also assessed by calculating the proportion of referrals with each of the items required for triaging.
At baseline, the lowest proportions of referral completeness were observed for family history of colorectal cancer [yes/no] (46 referrals; 42%) and full information on stated reason for referral (61 referrals; 55%). Of 56 referrals stating a positive faecal occult blood test (FOBT), 38% had the FOBT result attached. The PHN Primary Care Coordinator alerted regional general practices to these gaps in referral completeness through targeted engagement. The post-engagement audit showed that the proportion of referrals with documented family history (yes/no) had risen to 52% while the proportion of referrals with full information on stated reason for colonoscopy had risen to 67%. Of the 28 referrals stating a positive FOBT post-engagement, 64% had the FOBT result attached.
A collaborative partnership was developed between the ICS and PHN which, with the use of specific data, helped engage and inform GPs.