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Referral Criteria Index

Find referral triggers with citations and decision tags.

What this index covers

Referral thresholds

Locate escalation triggers quickly.

Specialty filters

Filter by service line or setting.

Decision context

See the evidence behind referral criteria.

What Are Referral Criteria?

Referral criteria are evidence-based thresholds and clinical indicators that guide healthcare professionals in determining when a patient should be referred to a specialist service or escalated to a higher level of care. They are a fundamental component of clinical pathways and decision support systems, designed to standardise and optimise patient flow within the NHS and other healthcare settings.

These criteria are typically derived from national guidelines, such as those published by the National Institute for Health and Care Excellence (NICE), specialist societies, and local integrated care board (ICB) policies. They help to ensure that referrals are appropriate, timely, and based on the best available evidence, thereby improving patient outcomes and making efficient use of finite healthcare resources.

Types of Referral Criteria

Referral criteria can be categorised into several distinct types based on their clinical purpose and urgency:

  • Diagnostic Referral Criteria: Used when specific symptoms, signs, or test results suggest a condition that requires specialist investigation (e.g., suspected cancer criteria under the two-week wait pathway).
  • Management Referral Criteria: Applied when a condition fails to respond to first-line treatment in primary care or when complex management is needed (e.g., referral to cardiology for heart failure with reduced ejection fraction despite optimal medical therapy).
  • Preventive Referral Criteria: Based on risk factors to prevent disease progression (e.g., referral to diabetic eye screening for patients with diabetes).
  • Urgent vs. Routine Criteria: Distinguish between conditions requiring immediate specialist attention and those that can be managed through planned outpatient care.

Why Are Referral Criteria Important?

The consistent application of referral criteria is critical for several reasons:

  • Patient Safety: They help identify patients who require specialist intervention, reducing the risk of delayed diagnosis or treatment for serious conditions.
  • Clinical Effectiveness: By standardising decision-making, they promote equitable and evidence-based care across different populations and geographies.
  • Operational Efficiency: They prevent inappropriate referrals, reducing waiting times for patients who genuinely need specialist input and minimising burden on secondary care services.
  • Governance and Audit: They provide a clear, auditable trail for referral decisions, supporting clinical governance, service evaluation, and quality improvement initiatives.

For clinicians, a centralised index of these criteria saves valuable time that would otherwise be spent searching through multiple disparate guidelines and local documents.

Impact on Healthcare Systems

Implementing standardised referral criteria has demonstrated significant benefits across the NHS. Studies have shown reductions in inappropriate referral rates by up to 30% in some specialties, leading to more efficient use of outpatient capacity. Furthermore, they support the NHS Long Term Plan's objectives by ensuring patients are seen by the right professional at the right time, reducing variations in care and supporting integrated care systems (ICSs) in managing population health.

How to Use This Index

The CliniSearch Referral Criteria Index is designed for rapid access and practical application. It aggregates criteria from authoritative sources and presents them in a standardised, filterable format.

Key Features for Users:

  • Search and Filter: Quickly locate criteria by specialty (e.g., Cardiology, Gastroenterology), clinical setting (e.g., primary care, emergency department), or specific condition.
  • Contextual Information: Each entry includes the specific clinical trigger (e.g., "HbA1c > 86 mmol/mol despite dual therapy"), the recommended action (e.g., "Refer to Diabetes Specialist Team"), and the source guideline with a direct citation.
  • Decision Tags: Criteria are tagged with metadata such as "Urgent," "Routine," "2WW (Two-Week Wait)," or "Suspected Cancer," helping to prioritise actions.

This tool is intended to support, not replace, clinical judgement. Always consider the individual patient's circumstances and adhere to local policies and pathways.

Navigation Tips

To get the most from this index:

  • Use the specialty filter to narrow down results to your area of practice.
  • Bookmark frequently used criteria for quick access during consultations.
  • Check the 'last updated' date to ensure you're viewing the most current guidance.
  • Utilise the cross-referencing feature to see related criteria for comorbid conditions.

Practical Checklist for Applying Referral Criteria

Before making a referral based on a criterion found in this index, consider the following steps to ensure a robust and patient-centred decision:

  1. Verify the Criterion: Confirm that the clinical finding or test result meets the exact threshold specified in the index.
  2. Check the Source: Review the source guideline citation to understand the context, strength of evidence, and any specific exclusions or nuances.
  3. Assess the Patient Holistically: Consider comorbidities, patient preferences, social factors, and overall clinical stability. Does the referral align with the patient's best interests?
  4. Consult Local Policy: Ensure the recommended action is in line with your local Integrated Care Board (ICB) or trust-specific referral pathways and forms.
  5. Document the Decision: Clearly record the specific referral criterion used, the source, and the clinical rationale in the patient's notes.
  6. Communicate Effectively: When making the referral, provide a clear summary of the clinical picture and the specific trigger that has been met to facilitate timely and appropriate triage by the receiving service.

Common Pitfalls to Avoid

While referral criteria are valuable tools, clinicians should be aware of potential limitations:

  • Over-reliance on Criteria: Criteria should inform rather than dictate decisions. Clinical judgement remains paramount.
  • Ignoring Patient Context: A patient may meet criteria but have contraindications to referral or prefer alternative management options.
  • Outdated Information: Always verify that the criterion reflects current guidance, as recommendations can change.
  • Local Variations: Some regions may have specific modifications to national criteria; always check local implementation guides.

Sources and Evidence Base

The criteria within this index are meticulously sourced from authoritative and evidence-based publications. Primary sources include:

  • National Institute for Health and Care Excellence (NICE): Guidelines, technology appraisals, and clinical knowledge summaries.
  • Specialist Societies: Guidelines from bodies such as the British Thoracic Society (BTS), Royal College of Physicians (RCP), and British Society of Gastroenterology (BSG).
  • NHS England Policy Directives: Including national directives on waiting times, such as the Two-Week Wait pathway for suspected cancer.
  • Scottish Intercollegiate Guidelines Network (SIGN): For practices relevant to Scotland.

Each entry is regularly reviewed and updated to reflect changes in national guidance. The date of the last source update is displayed alongside each criterion.

Evidence Grading System

Where available, criteria are accompanied by information about the strength of the supporting evidence. This typically follows the grading systems used by the source organisation:

  • NICE Evidence Levels: Classified from 1++ (high quality meta-analyses) to 4 (expert opinion).
  • Strength of Recommendation: Often indicated as 'Strong' or 'Conditional' based on benefit-risk balance and evidence quality.
  • Consensus Statements: Where formal evidence is limited, criteria may be based on formal consensus from expert panels.

Implementation in Clinical Practice

Successfully integrating referral criteria into daily practice requires more than just access to the information. Healthcare organisations should consider:

  • Staff Training: Ensure all relevant clinical staff are familiar with how to access and interpret the criteria.
  • Clinical Audit: Regularly audit referral patterns against criteria to identify areas for improvement.
  • Digital Integration: Where possible, integrate criteria into electronic health records and referral management systems.
  • Patient Information: Develop patient-facing materials that explain why a referral is being made based on established criteria.

Many NHS trusts have reported improved referral quality and reduced DNA (Did Not Attend) rates after implementing structured referral criteria systems supported by tools like this index.

Related resources

For more detailed information on how clinical thresholds are integrated into digital systems, visit our Clinical Thresholds feature page. To compare recommendations across different guidelines, explore our Guideline Comparisons tool.

Additional Support

Our Patient Safety Hub contains further resources on safe referral practices and learning from incidents. For organisational implementation support, see our Enterprise solutions.