Hospital triage of general practice referrals: exploring the role of triage in rejected referrals

Collaboration between General Practitioners (GPs) and specialised hospital services is essential for efficient, patient-centred care. In Denmark, GPs manage patients’ conditions and coordinate referrals to specialised services. Hospital referral triage consultants act as second-line gatekeepers, assessing the appropriate allocation of the patient or returning the referral to the GP when criteria are not met. The proportion of referrals rejected has increased, and inadequate communication between GPs and hospitals may contribute to these rejections. Understanding how triage consultants make decisions and coordinate care is critical for optimising referral pathways. This study aimed to explore the decision-making and coordination processes involved in rejected referrals from the perspective of hospital triage consultants. A qualitative design was employed using individual telephone interviews. Data were analysed following Braun and Clarke’s reflective thematic analysis. Ten hospital triage consultants participated, with 1 to 18 years of clinical experience, representing, orthopaedic surgery, urology, endocrinology, radiology, psychiatry, neurology, general medicine and haematology; four were female. Interviews lasted 21–37 min. Four themes emerged: (1) The referral process is influenced by specialisation and regulatory mandates, (2) Communication within the referral process – a remnant of the past, (3) The referral as a requested clinical task – Defining Scope and Responsibility, and (4) Selection of “the right patients” for specialised treatment. Findings indicate that triage consultants act as gatekeepers between GPs and specialist departments, balancing clinical information with departmental capacity. Structural and procedural constraints limit system flexibility. The consultants had several suggestions to improve the referral process quality and efficiency. Efficiency could be enhanced by revising legal and administrative constraints and optimising consultants’ workloads. Pathways work well for clearly defined cases, e.g., cancer-suspect cases, but poorly for patients with complex conditions requiring tailored approaches. Establishing accessible and flexible referral criteria can improve triage and the identification and prioritisation of patients with the greatest clinical needs. Improved collaboration between triage consultants, GPs, and patients, e.g., through direct contact or further correspondence, may enhance referral quality and overall patient care. These findings have identified practical strategies to strengthen hospital–primary care coordination and support resource-efficient, patient-centred pathways. Creating better opportunities for consultants to contact the GP and patient during triage of referrals. Enhancing communication through telephonic advice, video consultations, and correspondence. Improving the quality of, agreement on, and accessibility to criteria for referral acceptance. Expanding GPs’ role in coordinating complex patient care to ensure continuity. Reviewing regulative time constraints for patient management after an accepted referral. Reviewing workload and increasing efficiency while maintaining focus on high-priority cases. Creating an expansive referral strategy with fewer time constraints for patients with complex health conditions.