Referral Pathways to Radiology.pdf

Procedure

Referral Pathways – Radiology Service

Procedure Responsibilities and Authorisation
Department Responsible for Procedure
Radiology
Document Facilitator Name
Sally McMillan
Document Facilitator Title
Quality Manager
Document Owner Name
Dr Glenn Coltman
Document Owner Title
Radiology Clinical Unit Leader
Disclaimer: This document has been developed by Waikato District Health Board specifically for its
own use. Use of this document and any reliance on the information contained therein by any third party
is at their own risk and Waikato District Health Board assumes no responsibility whatsoever.

Procedure Review History
Version
Updated by
Date Updated
Summary of Changes

Doc ID:
6076
Version:
2.1
Issue Date:
15 MAY 2019
Review Date:  8 APR 2022
Facilitator Title:
Quality Manager
Department:
Radiology
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Procedure

Referral Pathways – Radiology Service

1
Overview
1.1  Purpose
To familiarise all Radiology department staff with the appropriate referral pathways to the
Radiology service at Waikato DHB

1.2  Scope
Radiology Service, Waikato DHB

1.3  Patient / client group
All clinicians, including RMO, SMO, and Nurse Practitioners with imaging referral
authority

1.4  Exceptions / contraindications
Registered Nurses with exemption for refer for imaging

1.5  Definitions
DHB
District Health Board
DOB
Date of Birth
ED
Emergency Department
GP
General Practitioner
MRT
Medical Radiation Technologist
NP
Nurse Practitioner
RMO
Resident Medical Officer
SMO
Senior Medical Officer

2
Roles and Responsibilities
2.1  RMO / SMO / Nurse Practitioner
•  Responsible clinician who signs the referral request, and whom has the overall
responsibility for the Radiology referral, including the acknowledgement of results
•  Shall record clearly and legibly.
•  Should seek advice from the on-call Radiology Registrar if in doubt around any aspect
of the referral, including urgency.

Doc ID:
6076
Version:
2.1
Issue Date:
15 MAY 2019
Review Date:  8 APR 2022
Facilitator Title:
Quality Manager
Department:
Radiology
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Procedure

Referral Pathways – Radiology Service

2.2  Clinical Unit Team Leader
•  Responsible for ensuring this policy is complied with in the Radiology Service
•  Communicating the results of audits with the referring RMO.

2.3  Clinical Director of an Area
•  Establishment of a prioritisation schedule for all referrals to their respective area.

2.4  Radiology Consultant and Radiology Registrar
•  Be available to offer general advice to referrers.

2.5  Unit Charge
•  Lead MRT/Sonographer who is responsible for the management of all referrals to their
respective Radiology area.
•  Ensure prioritisation of referrals is aligned to the prioritisation schedule set by the
Clinical Director of the department

3
Imaging Referral Criteria
All imaging referrals shall have included:

•  Correct Patient Identification (NHI, full name, DOB, Address)
•  Responsible Unit (Waikato DHB referrals)
•  Signature, with legible name and position
•  Referrer contact details
•  Date of referral
•  Sufficient clinical history to justify the imaging referral
•  A clinical question to be answered by imaging
•  Examination / correct body part for imaging
•  All other patient information that contributes to the management of the patient
•  Patient alerts regarding patient / client adverse drug reactions and allergies or other risk
alerts
•  Urgency
•  Communications with the Radiology department must be recorded on the referral
•  Clear and legible writing

Doc ID:
6076
Version:
2.1
Issue Date:
15 MAY 2019
Review Date:  8 APR 2022
Facilitator Title:
Quality Manager
Department:
Radiology
IF THIS DOCUMENT IS PRINTED, IT IS VALID ONLY FOR THE DAY OF PRINTING
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Procedure

Referral Pathways – Radiology Service

4
Conventional Imaging Process
4.1  Inpatients
Standard Working Hours (0800hrs – 1600hrs Monday to Friday):
All Inpatient imaging requests are to be sent to the Conventional Imaging department via
fax to 98918.
The referral is then graded by the Unit Charge of Conventional Imaging and will be
imaged according to priority.
The Radiology booking clerk will schedule the booking, liaise with the ward, and arrange
transport of patient.
After Hours:
All requests for inpatient bookings are to be sent to the Emergency x-ray department via
fax on 95736.
The prioritisation of inpatient imaging is performed by the MRT shift supervisor.
The MRT shift supervisor will schedule the booking, liaise with the ward, and arrange
transport of patient.

4.2  Mobile Imaging:
All requests for mobile imaging examinations are to be sent to the Emergency x-ray
department via fax on 95736.
Imaging will be performed in an appropriate time frame.

4.3  Emergency department
All imaging requests from the emergency department are to be sent to the Emergency X-
ray department via fax to 95736.
The prioritisation of the ED patient referral is performed by the MRT shift supervisor.
Patients will be collected by the Radiology Clinical Assistant and brought around to the
department for their imaging.

4.4  Outpatients
All outpatient imaging requests are to be sent with the patient to the Radiology
department, Reception D, Meade Clinical Centre.
All outpatient referrals will generally be imaged upon presentation to the department,
with the exception of complex cases, including skeletal surveys and child development
clinic spinal examinations which must be booked. Please fax these to 98918.
Patients will then be sent back to the clinic for follow up unless specifically asked not to.

Doc ID:
6076
Version:
2.1
Issue Date:
15 MAY 2019
Review Date:  8 APR 2022
Facilitator Title:
Quality Manager
Department:
Radiology
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Procedure

Referral Pathways – Radiology Service

4.5  GP / NP Referrals
All GP imaging referrals are to be sent to the Conventional Imaging department by Best
Practise.
The referral is then graded by the Unit Charge of Conventional Imaging and will be
imaged according to priority.
For any urgent requests for GP patient imaging please fax the request to 98894.

5
Fluoroscopy
5.1  Inpatients and Emergency department
Standard Working Hours (0800hrs – 1600hrs Monday to Friday):
All Inpatient imaging requests are to be sent to the Radiology department via fax 98918
The prioritisation of inpatient fluoroscopy is performed by the Radiology Registrar on for
Fluoroscopy that day, in liaison with the lead Fluoroscopy MRT.
For urgent inpatient requests please call 98624 to discuss.
After Hours:
All requests for inpatient bookings are to be sent to the ED X-ray department via fax to
95736. These must be discussed with the Radiology Registrar on call.
Non-urgent cases will not be imaged after hours.

5.2  Outpatients
All outpatient imaging requests are to be sent via fax to 98893.
The prioritisation of outpatient fluoroscopy imaging referrals is performed by the Unit
Charge of Conventional Imaging and patients will be imaged according to priority.

5.3  GP  Referrals
All GP fluoroscopy referrals are to be sent to the Conventional Imaging department by
Best Practice.
The prioritisation of GP referred imaging is performed by the Unit Charge of
Conventional Imaging and patients will be imaged according to priority.

Doc ID:
6076
Version:
2.1
Issue Date:
15 MAY 2019
Review Date:  8 APR 2022
Facilitator Title:
Quality Manager
Department:
Radiology
IF THIS DOCUMENT IS PRINTED, IT IS VALID ONLY FOR THE DAY OF PRINTING
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Procedure

Referral Pathways – Radiology Service

6
CT
6.1  Inpatients, Emergency department
Standard Working Hours (0800hrs – 1600hrs Monday to Friday)
All Inpatient imaging requests are to be sent to the CT department via Fax 94972 or in
person.
The received referral form will be protocolled and prioritised, depending on clinical
indications and urgency, by the CT rostered Radiologist or Radiology registrar.
The CT booking clerk will schedule the booking.
Bookings – After Hours and Weekends
All referring doctors call the Radiology on-call registrar to arrange.
The CT MRT will schedule the booking.

6.2  Outpatients
All outpatient imaging requests are to be sent to the CT department via Fax 98894, mail
or by best practice
The prioritisation of outpatient imaging is performed via selected Radiologists.
Should any diagnostic CT examination be identified as exceeding the recommended
wait time the Radiology Booking Clerk will notify the referring clinician, requesting them
to contact the Radiology CT department to discuss if the urgency of the request has
been underestimated.

7
Ultrasound
7.1  Complete regional examinations versus clinically targeted examinations
The department performs two broad categories of scans:
•  complete regional examinations
•  clinically targeted scans.

An example of a complete regional examination is a complete upper abdominal
ultrasound examination, whereas a targeted scan is a hepatobiliary examination only.
The referring doctor, sonographer or radiologist can determine the appropriateness and
scope of the examination to be performed.

Doc ID:
6076
Version:
2.1
Issue Date:
15 MAY 2019
Review Date:  8 APR 2022
Facilitator Title:
Quality Manager
Department:
Radiology
IF THIS DOCUMENT IS PRINTED, IT IS VALID ONLY FOR THE DAY OF PRINTING
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Procedure

Referral Pathways – Radiology Service

7.2  Inpatients
All inpatient imaging requests are to be sent to the Ultrasound department via Fax
98893, or bought to the department in person.
The prioritisation of inpatient scans is performed by a senior sonographer. In the
absence of a senior sonographer, the attending radiologist prioritises scans.
Standard Working Hours (0800hrs – 1630hrs Monday to Friday)
Inpatient bookings are arranged by the sonographer on non-clinical duties in the first
instance or by any other sonographer or receptionist once the referrals have been
prioritised. The individual who is making a booking is responsible for ensuring that a) the
booking has been entered into the radiology information system (Karisma), b) the ward
has been advised of the appointment time and patient preparation and c) transport of the
patient to our department has been arranged via attendant services.
After Hours and Weekends
All referring doctors are to contact the Radiology on-call registrar.  If the scan is
accepted the Radiology registrar will arrange a time and the ward will be asked to
arrange transport.  The Radiology registrar will contact the Sonographer on-call.

7.3  Outpatients
All outpatient imaging requests are to be sent to the Ultrasound department via Fax
98894, or by Best Practice.
Outpatient referrals are prioritised by senior Sonographers and Radiologists into priority
categories using standard referral guidelines available in the prioritisation folder.
Bookings are managed by the Ultrasound Booking Clerk.

7.4  GP / NP Referrals
All GP/NP imaging referrals are to be sent to the Ultrasound department via Best
Practice.
The prioritisation of GP/NP referred imaging is performed by senior Sonographers and
Radiologists in accordance to the Midland Region Community Access Criteria (2016).
Bookings are managed by the Ultrasound Booking Clerk.

Doc ID:
6076
Version:
2.1
Issue Date:
15 MAY 2019
Review Date:  8 APR 2022
Facilitator Title:
Quality Manager
Department:
Radiology
IF THIS DOCUMENT IS PRINTED, IT IS VALID ONLY FOR THE DAY OF PRINTING
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Procedure

Referral Pathways – Radiology Service

8
Interventional Radiology
8.1  Inpatients
The minimum acceptable level of referrals to Interventional Radiology is from a
Registrar.  The case MUST have been discussed with their team consultant first.
Standard Working Hours (0800hrs – 1600hrs Monday to Friday)
All imaging requests by Registrars or SMO’s must initially be discussed with the IR
Co-ordinator on 0212860115.
The IR co-ordinator will then discuss the patient and procedure requested with the IR
Consultant. Following this discussion the IR Co-ordinator will advise the referrer to send
the Referral form to the IR department via fax 94456
After Hours
For all acute referrals after hours to IR call the Radiology on-call registrar to discuss.
The Radiology registrar will cascade the appropriate IR staff.
8.2  Outpatients
Access to the Interventional Radiology service is limited to Waikato DHB Consultants
only, therefore patients must be referred to the appropriate outpatient service.
That service will then fax a referral to IR using the specific IR referral form.
Referrals can be faxed to 94456
Once a referral has been received it will be prioritised by the Interventional Radiologist
and then scheduled accordingly.
The IR booking clerk, Vascular booking clerk or the Neuro booking clerk (depending on
the procedure) will then contact the patient.

Doc ID:
6076
Version:
2.1
Issue Date:
15 MAY 2019
Review Date:  8 APR 2022
Facilitator Title:
Quality Manager
Department:
Radiology
IF THIS DOCUMENT IS PRINTED, IT IS VALID ONLY FOR THE DAY OF PRINTING
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Procedure

Referral Pathways – Radiology Service

9
Nuclear Medicine
9.1  Inpatients, Emergency department (SMO request only)
Standard Working Hours (0800hrs – 1630hrs Monday to Friday)
All inpatient imaging requests are to be sent to the Nuclear Medicine/Molecular Imaging
department via fax 98894.
The prioritisation of inpatient imaging is performed by the head of department or
Radiologist.
Examinations are assessed and scheduled within 1-2 hours of receipt of the referral,
dependant on radiotracer and scanner availability.
The Nuclear Medicine booking clerk will schedule the appointment. All patients will be
sent an information document, pregnancy/breastfeeding status, and appointment details.

9.2  Outpatients  (SMO request only)
All outpatient imaging requests are to be sent to the Nuclear Medicine/Molecular Imaging
department via fax 98894.
The prioritisation of inpatient imaging is performed by the head of department or
Radiologist.
Examinations are assessed daily and scheduled.
The Nuclear Medicine booking clerk will schedule the appointment. All patients will be
sent an information document, pregnancy/breastfeeding status, and appointment details.

9.3  GP Referrals
GP referral access limited to bone and thyroid (Following Endocrinologist review).
All imaging requests by GP’s are to be sent to the Nuclear Medicine/Molecular Imaging
department via fax 98894.
The prioritisation of GP imaging is performed by the head of department or Radiologist.
Examinations are assessed daily and scheduled.
The Nuclear Medicine booking clerk will schedule the appointment. All patients will be
sent an information document, pregnancy/breastfeeding status, and appointment details.

Doc ID:
6076
Version:
2.1
Issue Date:
15 MAY 2019
Review Date:  8 APR 2022
Facilitator Title:
Quality Manager
Department:
Radiology
IF THIS DOCUMENT IS PRINTED, IT IS VALID ONLY FOR THE DAY OF PRINTING
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Procedure

Referral Pathways – Radiology Service

10  Thames Hospital Process
10.1  Inpatients
Standard Working Hours (0800hrs to 1630hrs, Monday to Friday):
All Inpatient imaging requests are to be sent to 07 868 6080 via Fax.
The referral is then graded by the MRT and will be imaged according to priority.
The MRTs will schedule the booking, liaise with the ward, and arrange transport of
patient.
After Hours:
All requests for inpatient bookings are to be sent to 07 868 6080 via fax.
If necessary the referring doctor will call in the MRT on duty via Thames switch board.

10.2  Mobile Imaging
All requests for mobile imaging examinations are to be sent to the 07 868 6080
department via fax.
Imaging will be performed in an appropriate time frame. Call the MRTs on 28877 for any
x-rays that are required immediately.

10.3  Emergency department
All imaging requests from the emergency department are to be sent to 07 868 6080
department via fax.
The prioritisation of the ED patient referral is performed by the MRT.
The MRT will liaise with the ward, and arrange transport of patient.

10.4  Outpatients
All outpatient imaging requests are to be sent to the x-ray department,  located in the
Thames Clinical Centre or faxed to 07 8686080
All outpatient referrals where the patient will go back to the doctor will be imaged upon
presentation to the department, all others will be sent an appointment.
Patients will then be sent back to the clinic for follow up unless specifically asked not to.

10.5  GP / NP Referrals
All GP imaging referrals are to be sent to the Thames Hospital Radiology via Best
Practise E-Referrals.
The referral is then graded by Senior MRT’s and will be imaged according to priority.
For any urgent requests for GP patient imaging please call the department on
078680047
Doc ID:
6076
Version:
2.1
Issue Date:
15 MAY 2019
Review Date:  8 APR 2022
Facilitator Title:
Quality Manager
Department:
Radiology
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Procedure

Referral Pathways – Radiology Service

10.6  CT
Standard Working Hours (0800hrs to 1630hrs, Monday to Friday):
All  ED / Outpatient / Inpatient CT requests are to be sent to the x-ray
department,  located in the Thames Clinical Centre or faxed to 07 8686080
The referral is then graded by the Radiologist and will be imaged according to priority.
The MRTs will schedule the booking, liaise with the ward, and arrange transport of
patient. For outpatient referrals an appointment will be sent to the patient.
After Hours:
All requests for CT have to be discussed with the Radiology Registrar on call via
Thames switch board . All referrals are to be sent to 07 868 6080 via fax
The Radiology Registrar will call in the MRT on duty if necessary.

Doc ID:
6076
Version:
2.1
Issue Date:
15 MAY 2019
Review Date:  8 APR 2022
Facilitator Title:
Quality Manager
Department:
Radiology
IF THIS DOCUMENT IS PRINTED, IT IS VALID ONLY FOR THE DAY OF PRINTING
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Procedure

Referral Pathways – Radiology Service

11  Tokoroa Hospital Process
11.1  Inpatients
Standard Working Hours (0800 hrs to 1630 hrs, Monday to Friday):
All Inpatient imaging requests are to be sent to Radiology via the inpatient staff or
attendants.
The referral is then graded by one of the MRT’s and will be imaged according to priority.
The MRT’s will schedule the booking, liaise with the ward, and arrange transport of the
patient.
After Hours:
All non-urgent requests for inpatient bookings are to be sent to Radiology via inpatient
staff or attendants. If the x-ray is required urgently, the on-call MRT should be contacted.
The prioritisation of inpatient imaging is performed by the on call radiographer.
The on call radiographer will schedule the booking, liaise with the ward, and the inpatient
staff will arrange transport of patient.

11.2  Mobile Imaging:
All requests for mobile imaging examinations are to be sent to the Radiology department
via the ED or inpatient staff.
Imaging will be performed in an appropriate time frame.

11.3  Emergency department
All imaging requests from the Emergency department are to be sent to the Radiology
department via the ED staff or via phone contact with the on-call MRT.
The prioritisation of the ED patient referral is performed by the MRT’s.
Patients will be brought around to the department for their imaging by the MRT in most
cases or attendants and nursing staff when extra support is required.

11.4  Outpatients
All outpatient imaging requests are to be sent with the patient to the radiology
department, waiting room, with the patient.
All outpatient referrals will generally be imaged upon presentation to the department,
with the exception of complex cases, including (skeletal surveys) and imaging that can’t
be completed immediately for the clinic, which must be booked. Please send these to the
Radiology department.
Patients will then be sent back to the clinic for follow up unless specifically asked not to.

Doc ID:
6076
Version:
2.1
Issue Date:
15 MAY 2019
Review Date:  8 APR 2022
Facilitator Title:
Quality Manager
Department:
Radiology
IF THIS DOCUMENT IS PRINTED, IT IS VALID ONLY FOR THE DAY OF PRINTING
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Procedure

Referral Pathways – Radiology Service

11.5  GP / NP Referrals
All GP imaging referrals are to be sent to the X-ray department preferably via Best
Practise. Phone appointments won’t be accepted unless the form has been received
from the referrer.
The referral is then graded by the MRT’s and will be imaged according to priority.
For any urgent requests for GP patient imaging please phone the Radiology department
to arrange an appointment The Emergency department must also be contacted if a see
and treat is required.

Doc ID:
6076
Version:
2.1
Issue Date:
15 MAY 2019
Review Date:  8 APR 2022
Facilitator Title:
Quality Manager
Department:
Radiology
IF THIS DOCUMENT IS PRINTED, IT IS VALID ONLY FOR THE DAY OF PRINTING
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Procedure

Referral Pathways – Radiology Service

12  Te Kuiti Hospital Process
12.1  Inpatients
Standard Working Hours 0800 hrs to 1630hrs, Monday to Friday):
All Inpatient imaging requests are to be sent to Radiology via a ward nurse.
The referral is then graded by Unit Charge MRT and will be imaged according to priority.
The Unit Charge MRT will schedule the booking, liaise with the ward.

12.2  Mobile Imaging:
All requests for mobile imaging examinations are to be sent to the Radiology department
via a nurse.
Imaging will be performed in an appropriate time frame.

12.3  Emergency department
All imaging requests from the emergency department are to be sent to the Radiology
department via Nurse.
The prioritisation of the ED patient referral is performed by the MRT.
Patients will be brought around to the department for their imaging by Nurse.

12.4  Outpatients
All outpatient imaging requests are to be sent with the patient to the Radiology
department, which is next door to Radiology and Main Reception
All outpatient referrals will generally be imaged upon presentation to the department,
with the exception of complex cases, which must be booked.
Patients will then be sent back to the clinic for follow up unless specifically asked not to.

12.5  GP / NP Referrals
All GP imaging referrals are to be sent to the X-ray department by Best Practise.
The referral is then graded by Unit Charge MRT and will be imaged according to priority.
For any urgent requests for GP patient imaging please note the GP will ring to see if an
appropriate date and time is available for the patient to have examination done.

Doc ID:
6076
Version:
2.1
Issue Date:
15 MAY 2019
Review Date:  8 APR 2022
Facilitator Title:
Quality Manager
Department:
Radiology
IF THIS DOCUMENT IS PRINTED, IT IS VALID ONLY FOR THE DAY OF PRINTING
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Procedure

Referral Pathways – Radiology Service

13  Taumarunui Hospital Process
13.1  Inpatients, ED patients, Mobile imaging
Standard Working Hours (0800 hrs to 1630 hrs, Monday to Friday):
All Inpatient imaging requests are to be sent to Taumarunui radiology via fax: 07 896
0025 or internal mail.
The referral is then graded by the radiographers and will be imaged according to priority.
The radiographers will schedule the booking, liaise with the ward, and arrange transport
of patient.
After Hours:
All after hours imaging requests must be in-keeping with the Waikato DHB After Hours
Imaging - Southern Rural Hospitals guideline.
All requests for inpatient bookings are to be given to the Co-ordinating Shift Nurse, who
is responsible for contacting the on-call MRT.  The request form is then hung on the wall
in the ED office for the MRT to collect.

13.2  Outpatients
All outpatient imaging requests are to be sent with the patient to the radiology
department.
All outpatient referrals will generally be imaged upon presentation to the department.
Patients will then be sent back to the clinic for follow up unless specifically asked not to.

13.3  GP / NP Referrals
All GP imaging referrals are to be sent to the X-ray department by Best Practise, or can
be given to the patient to present to the department.
The referral is then graded by the radiographers and will be imaged according to priority.
For any urgent requests for GP patient imaging please phone the x-ray department, 07
896 0040.

Doc ID:
6076
Version:
2.1
Issue Date:
15 MAY 2019
Review Date:  8 APR 2022
Facilitator Title:
Quality Manager
Department:
Radiology
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Procedure

Referral Pathways – Radiology Service

14  Administration
Clerical staff maintain a confirmation message service for patients to confirm their allocated
appointments. Every reasonable effort is made to accommodate patient’s preference in terms
of date and time of appointments.
Patients who do did not attend their appointment without notification or rescheduling have their
referral documents returned to the referrer.

15  Audit
15.1  Indicators
•  100% of Radiology referrals completed will be accurate and acceptable to the service.
•  100% of Radiology referrals will have the correct patient information and correct side
recorded.

15.2  Tools
•  Radiology Referral Quality Audit process

16  Legislative Requirements
16.1  Legislation
•  Radiation Safety Act (2016)

16.2  External Standards
•  Ministry of Health Office of Radiation Safety Code of Practice C1, C3

17  Associated Documents
•  Waikato DHB: Specialty Referral Guidelines (Ref. 5295)
•  Waikato DHB: Clinical Records Management (Ref. 0182)
•  Waikato DHB: Trauma Protocol (Ref. 1538)
•  National Criteria for Access to Community Radiology 2015

Doc ID:
6076
Version:
2.1
Issue Date:
15 MAY 2019
Review Date:  8 APR 2022
Facilitator Title:
Quality Manager
Department:
Radiology
IF THIS DOCUMENT IS PRINTED, IT IS VALID ONLY FOR THE DAY OF PRINTING
Page 17 of 17