Standards › ASF Health Standards v10 › Standard 59
Standard 59
Outpatient Medical Specialties
Outpatient medical specialties: referrals triaged and tracked to an appointment, specialist consultations assessed and consented within the clinician scope, results communicated and missing results followed up, medicines reviewed at each visit, and recall and follow-up planned..
Each criterion is shown in three settings: Humanitarian settings, Transition and fragile, and Standard. In standard settings, every criterion is Must.
Training colours: red means essential, green recommended, yellow optional. Each course shows its level for each setting: humanitarian, transition and fragile, and standard.
59.1Specialist Referrals Are Triaged and Tracked to an AppointmentHumanitarian settings: MinimumTransition and fragile: MustStandard: Must
Every referral to a specialist clinic is triaged on receipt against a set criteria list. Urgent referrals are seen within the set time, and every referral is tracked until the patient is seen or the referral is closed.
Why it matters.
How the surveyor verifies this criterion
Sample. Review the referral log for the clinic for the last 3 months, including every urgent referral and a random sample of routine referrals.
Immediate fail (any one means the criterion is not met). An urgent referral sits in a tray for six weeks, and the patient presents with a delayed diagnosis.
Staff responsible
| Role | Responsibility | Level |
|---|---|---|
| Manager (ISCO 1342) | Checks the criterion at each review | Must |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| PHC-SOP-003 · Referral criteria and referral tracking | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
| PHC-REG-002 · Referral tracking register | Secretary (ISCO 3344) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
E-learning: who must take each course
| Course | Who must take it |
|---|---|
| Access & Arrival: From Street to Consulting Room (AMB-01) | Manager; Nurse |
References
- Suspected cancer: recognition and referral (NG12) (National Institute for Health and Care Excellence (NICE), 2015 (last updated 2026))
59.2Specialist Consultations Are Assessed, Consented and Within the Clinician ScopeHumanitarian settings: MinimumTransition and fragile: MustStandard: Must
Each specialist consultation begins with a documented assessment and informed consent. The clinician is verified as qualified and within scope for the service delivered, and the outcome is sent to the referring clinician.
Why it matters.
How the surveyor verifies this criterion
Sample. Review the consultation records and the clinician scope register for a sample of specialist consultations in the last 6 months.
1. Each consultation begins with a documented assessment.
Method. Check each sampled consultation for the assessment entries.
Evidence to show. Specialist consultation record (OMS-FRM-001).
Pass when. Every sampled consultation has the assessment recorded.
2. The outcome is sent to the referring clinician.
Method. Check each sampled consultation for the letter sent to the referrer.
Evidence to show. Specialist consultation record (OMS-FRM-001).
Pass when. Every sampled consultation has the outcome sent to the referrer.
Immediate fail (any one means the criterion is not met). A clinician performs a procedure outside the scope on their register, and the patient suffers a complication.
Staff responsible
| Role | Responsibility | Level |
|---|---|---|
| Nurse (ISCO 2221) | Completes the Specialist consultation procedure (OMS-SOP-001); specialist consultation record | Must |
| Manager (ISCO 1342) | Checks the criterion at each review | Must |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| OMS-SOP-001 · Specialist consultation: assessment, consent and clinician scope | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
| OMS-FRM-001 · Specialist consultation record | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
E-learning: who must take each course
| Course | Who must take it |
|---|---|
| Care & Treatment: Twelve Clinical Criteria for Safe Ambulatory Practice (AMB-04) | Manager; Nurse |
References
In process of development. Will be available soon.
59.3Results Are Communicated and Missing Results Are Followed UpHumanitarian settings: MinimumTransition and fragile: MustStandard: Must
Results of tests done in the clinic are communicated to the patient and the referring clinician. Critical results are reported at once, and results not received within the set time are chased and recorded.
Why it matters.
How the surveyor verifies this criterion
Sample. Review the results log and the missing results records for the clinic for the last 6 months, including every critical result.
Immediate fail (any one means the criterion is not met). A critical blood result is not reported, and the patient is not told for ten days.
Staff responsible
| Role | Responsibility | Level |
|---|---|---|
| Manager (ISCO 1342) | Checks the criterion at each review | Must |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| OMS-SOP-003 · OMS-SOP-003 | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
E-learning: who must take each course
| Course | Who must take it |
|---|---|
| Aftercare & Follow-up: Closing the Loop After Every Visit (AMB-06) | Manager; Nurse |
References
- WHO (2021). Global Patient Safety Action Plan 2021–2030: Towards Eliminating Avoidable Harm in Health Care. Used for: Communication and follow-up of results https://news.gmj.ge/guideline/global-patient-safety-action-plan-2021-2030-towards-eliminating-avoidable-harm-in-health-care/
59.4Medicines Are Reviewed at Each Visit and Language Access Is ProvidedHumanitarian settings: MinimumTransition and fragile: MediumStandard: Must
Medicines are reviewed and reconciled at each visit, with changes recorded. Patients who need an interpreter are offered one, and its use is recorded.
Why it matters.
How the surveyor verifies this criterion
Sample. Review the visit records and interpreter use records for a sample of patients in the last 6 months.
1. Medicines are reviewed and reconciled at each visit, and changes are recorded.
Method. Check each sampled visit for the review and any change recorded.
Evidence to show. Outpatient medicines review record (OMS-FRM-002).
Pass when. Every sampled visit has the medicines review recorded.
Immediate fail (any one means the criterion is not met). A patient who does not speak the language is given instructions for a new medicine with no interpreter, and takes the wrong dose.
Staff responsible
| Role | Responsibility | Level |
|---|---|---|
| Nurse (ISCO 2221) | Completes the Outpatient medicines review record (OMS-FRM-002); medicines reconciliation | Medium |
| Manager (ISCO 1342) | Checks the criterion at each review | Medium |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| OMS-FRM-002 · Outpatient medicines review record | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
E-learning: who must take each course
| Course | Who must take it |
|---|---|
| Medication Safety: Operating SOP-MED-01 End to End (T-08) | Manager; Nurse |
References
- WHO (2017). Medication Without Harm – Global Patient Safety Challenge on Medication Safety. Used for: Medicines review at each visit https://news.gmj.ge/guideline/medication-without-harm-global-patient-safety-challenge-on-medication-safety/
59.5Follow-Up and Recall Are Planned for Every PatientHumanitarian settings: MinimumTransition and fragile: MediumStandard: Must
Each patient has a follow-up or recall plan set at the visit, with the date recorded. Patients who miss a planned review are contacted and the outcome is recorded.
Why it matters.
How the surveyor verifies this criterion
Sample. Review the follow-up and recall records for every outpatient in the last 6 months, including patients who missed a review.
1. Each patient has a follow-up or recall plan with a date recorded at the visit.
Method. Check each sampled visit for a recorded follow-up or recall date.
Evidence to show. Outpatient recall and follow-up register (OMS-REG-001).
Pass when. Every sampled visit has a follow-up or recall date recorded.
2. The outcome of each contact is recorded.
Method. Check each contact entry for the outcome.
Evidence to show. Outpatient recall and follow-up register (OMS-REG-001).
Pass when. Every contact has a recorded outcome.
Immediate fail (any one means the criterion is not met). A patient with a diabetes medicine change misses the review, is not contacted, and presents with hyperglycaemia.
Staff responsible
| Role | Responsibility | Level |
|---|---|---|
| Secretary (ISCO 3344) | Keeps the Outpatient recall and follow-up register (OMS-REG-001); recall test record (PHA-FRM-002, existing, reused); screening recall and result register | Medium |
| Manager (ISCO 1342) | Checks the criterion at each review | Medium |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| OMS-REG-001 · Outpatient recall and follow-up register | Secretary (ISCO 3344) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
E-learning: who must take each course
| Course | Who must take it |
|---|---|
| Aftercare & Follow-up: Closing the Loop After Every Visit (AMB-06) | Manager; Nurse |
References
- Suspected cancer: recognition and referral (NG12) (National Institute for Health and Care Excellence (NICE), 2015 (last updated 2026))
- Operational framework for primary health care: transforming vision into action (World Health Organization, 2020)
Who is responsible for Standard 59
Each criterion names the positions responsible for it. Every position links to its own terms of reference.
| Criterion | Responsible | Supports |
|---|---|---|
| 59.1 Specialist Referrals Are Triaged and Tracked to an Appointment | Consultant physician (internal medicine) Appointments clerk |
Medical secretary |
| 59.2 Specialist Consultations Are Assessed, Consented and Within the Clinician Scope | Head of department (per specialty) Consultant physician (internal medicine) |
Competency assessor |
| 59.3 Results Are Communicated and Missing Results Are Followed Up | Consultant physician (internal medicine) | Registered nurse |
| 59.4 Medicines Are Reviewed at Each Visit and Language Access Is Provided | Clinical pharmacist Consultant physician (internal medicine) |
Interpreter (medical) |
| 59.5 Follow-Up and Recall Are Planned for Every Patient | Practice manager | Appointments clerk |
Role details: reporting, supervision and training
Training shown is the general recommendation. Role-specific training is set in the next improvement round.
| Role | Reports to | Supervises | Recommended training |
|---|---|---|---|
| Head of department (per specialty) | Medical director | Consultant physician (internal medicine), Resident physician / house officer | Facility induction; safeguarding adults (general recommendation) |
| Consultant physician (internal medicine) | Head of department (per specialty) | Resident physician / house officer | Facility induction; safeguarding adults (general recommendation) |
| Registered nurse | Head nurse / ward manager | Nursing associate, Health care assistant / nursing aide | Facility induction; safeguarding adults (general recommendation) |
| Interpreter (medical) | Patient services manager | None | Facility induction; safeguarding adults (general recommendation) |
| Clinical pharmacist | Chief pharmacist | None | Facility induction; safeguarding adults (general recommendation) |
| Appointments clerk | Patient services manager | None | Facility induction; safeguarding adults (general recommendation) |
| Medical secretary | Head of department (per specialty) | None | Facility induction; safeguarding adults (general recommendation) |
| Competency assessor | Training and education manager | None | Facility induction; safeguarding adults (general recommendation) |
| Practice manager | Medical director | Clinic reception and front desk, Triage and telephone nurse, Patient flow coordinator (clinic) | Facility induction; safeguarding adults (general recommendation) |
Questions and answers
The criterion text is the authority. These answers summarise it.
Who does Standard 66 apply to?
Outpatient specialist clinics that see patients by referral from another clinician, including the consultations, tests and follow-up that go with them.
What do the colours mean for this standard?
Red (Must) is required. Green (Medium) is recommended. Yellow (Minimum) is the lowest acceptable level in humanitarian settings. Standard setting is Must on every criterion.
How are referrals handled?
Under 59.1 every referral is triaged on receipt against a set list, urgent referrals are seen within the set time, and each referral is tracked until the patient is seen.
Is each consultation consented and in scope?
Yes. Under 59.2 each consultation starts with a documented assessment and informed consent, and the clinician is verified as qualified for the service.
Are results followed up?
Under 59.3 results are sent to the patient and referrer, critical results are reported at once, and results not received within the set time are followed up.
Are medicines reviewed at each visit?
Under 59.4 medicines are reviewed and reconciled at each visit, and patients who need an interpreter are offered one, with its use recorded.
Is follow-up planned?
Under 59.5 each patient has a follow-up or recall plan with a recorded date, and patients who miss a review are contacted.
Guidelines for this standard
5 guideline(s) are held in the GMJ Guidelines Library and listed here. Each link opens the full guideline on news.gmj.ge. The complete library, grouped by standard, is at Guidelines.
- Operational Framework for Primary Health Care: Transforming Vision into Action (WHO/UNICEF)
- Suspected Cancer: Recognition and Referral (NICE NG12) (NICE)
- Suspected cancer: recognition and referral (NG12) — safety netting (NICE)
- Diabetes type 2 in adults — MSF Clinical guidelines (Médecins Sans Frontières)
- Panorama of Diabetes in the Americas (Pan American Health Organization)
Also relevant to this standard:
- Medication Without Harm – Global Patient Safety Challenge on Medication Safety (World Health Organization)