Medical referrals: introducing a GP-priority clerking shift to ensure equitable patient care

The Society of Acute Medicine (SAM) guidelines indicate that all medical patients should be assessed within 4 hours of referral. Our initial audit cycle revealed that in our institution, significantly less patients referred via their GP were seen within recommended time, when compared with patients referred via the Emergency Department (ED). We undertook a targeted educational intervention, improved the communication process for referrals and modified the senior house officer (SHO) clerking rota, and re-audited the service to determine the effect of these changes. Subsequently, the proportion of GP-referred patients reviewed within recommended time significantly improved for both initial clerking (from 60% to 95.5%, p=0.011) and consultant review (from 50% to 90.5%, p=0.009), with no detrimental effect on waiting times for ED-referred patients. This is likely to be clinically important, impacting on best practice and patient safety.