Inclusion and exclusion criteria
| Selection criteria | Inclusion criteria | Exclusion criteria |
| Population patients | •Adults (aged 16 years+) | •Children (aged <16 years) |
| •With a non-urgent condition | •With an urgent condition requiring emergency or urgent referral •“Red flag” back symptoms •Any evaluation of cancer–eg, fitting UK “2-week rule” guidelines | |
| •Guideline consultation –In primary care by a PCP/GP | •Guideline consultation –In primary dental care by general dental practitioner –Undertaken by optician/optometrist –In Accident and Emergency department –In secondary care | |
| •Condition should be amenable to surgical intervention if severe enough •Do include infertility if referral is from primary to secondary care; back pain if surgery is an option; glaucoma if referral is from primary to secondary care and surgery is an option; breast symptoms if non-urgent component | •Condition not amenable to surgical intervention | |
| Population practitioners | •Referring practitioner is GP or PCP | •Referring practitioner is not a PCP (eg, in referral to tertiary or high dependency care facilities) |
| •Receiving practitioner is a surgeon or practitioner in surgical specialty in secondary care | •Receiving practitioner is a someone other than a surgeon or practitioner in a surgical specialty (eg, social services, complementary therapies, district nursing, etc) | |
| Interventions | •Any guideline(s) or set of rules or protocol that assists PCPs with a decision of whether or not to refer patients to a surgeon or surgical specialty in secondary care for further advice, consultation or treatment | •There is no identifiable (repeatable, written) set of rules that could be generalised to GP/PCPs in—eg, another geographic area |
| •Referral for endoscopy or other diagnostic tests if referral is for management of symptoms, not just for investigation | •Referral is for diagnostic tests only •Back pain if referral is for physiotherapy or imaging | |
| Outcomes | Any assessments of •Appropriateness of referral •Change in GP/PCP knowledge •Change in disease status/change in health status/quality of life •Costs | •Outcomes identified do not fall into the five identified categories of outcome |
| Study designs | •No study design excluded | •No study design excluded |
| •Evaluation of a referral guideline OR study measuring compliance with specific named guideline (comparison of actual practice with guideline) | •No evaluation or comparison with guideline •No specific, clear, identifiable guideline(s) named | |
| •Publication must be research based with original data | •No original data or research (or duplicate data or research) are presented |
GP, general practitioner; PCP, primary care practitioner.