Audit of referrals

Audit of referrals is difficult and time consuming; it may however give you valuable insight into your clinical practice and may lead to change. One of the main difficulties in examining your referral practice is that there is an up to 2-5 fold difference in the referral habits of doctors. Studies have shown that referral rates are multifactorial and are heavily influenced by deprivation indices. Audit therefore should not seek to apportion “blame” but to assess whether you can identify areas for improvement and / or learning needs.

“Inappropriate” referral levels have been measured and found to be low (of the order of 13% overall) and as such audit could focus on process as opposed to outcomes. A simple way to assess your referral patterns would be to compare it to other practitioners in your own practice and adjust for the numbers of clinical contacts that generated those referrals.

Suggested audit topics:

  • Crude referral rates – matched to practice colleagues and LHB levels
  • Specialty referral rates – are my referral rates compatible to LHB average in this specialty
  • Area? (Don’t forget to allow for personal factors e.g. special interests, sex, practice profile etc.)
  • Numbers of referral letters containing appropriate clinical details
  • Emergency admissions
  • Outcome of out-patient appointment v. initial referral reason



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