title: Written advice can provide a safe and acceptable alternative to new patient assessment for selected referrals to haematologists.
abstract: OBJECTIVE
  To measure the safety and acceptability of providing written advice (WA) for selected patients referred to a haematology service, as an alternative to inpatient or outpatient assessment.
  
  
  METHODS
  Review of the initial management and subsequent course of patients newly referred to a tertiary referral hospital in Christchurch, New Zealand, between 16 October 2003 and 8 June 2006. Structured questionnaires were sent to all referring doctors and patients recently managed with WA.
  
  
  METHODS
  Numbers and diagnoses of patients managed with WA, early assessment or delayed assessment; re-referral and treatment details; characteristics of WA letters; and opinions of referring doctors and their patients on the WA process.
  
  
  RESULTS
  26% of new referrals (714/2785) were managed with prompt WA, while 16% (455/2785) received the alternative of delayed assessment. After a median follow-up of 23 months (range, 8-40 months), 13% of those managed with WA (91/714) were re-referred back to the same haematologists; 7% (52/714) were assessed in hospital and 2% (15/714) eventually required treatment. There were no deaths due to haematological causes. Over 90% of responding referring doctors said the WA process was rapid and effective, and 77% of recently managed patients were pleased to be treated by their own doctors.
  
  
  CONCLUSIONS
  Using WA to manage a substantial minority of patients referred to haematologists can be rapid and safe. It is widely accepted by referring doctors.
authors.affiliation: Department of Haematology, Canterbury Health Laboratories and Christchurch Hospital, Christchurch, New Zealand. peter.ganly@cdhb.govt.nz
authors.forename: Peter S
authors.initials: PS
authors.lastname: Ganly
authors.forename: Helen
authors.initials: H
authors.lastname: Keeman
authors.forename: Ruth L
authors.initials: RL
authors.lastname: Spearing
authors.forename: Mark P
authors.initials: MP
authors.lastname: Smith
authors.forename: Nigel
authors.initials: N
authors.lastname: Patton
authors.forename: Eileen G
authors.initials: EG
authors.lastname: Merriman
authors.forename: Steve S
authors.initials: SS
authors.lastname: Gibbons
mesh_terms: D015709:Correspondence as Topic; D003376:Counseling; D005500:Follow-Up Studies; D006402:Hematologic Diseases / Q000175:diagnosis; D006405:Hematology; D006801:Humans; D009520:New Zealand; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation