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Eight of the 15 study participants were willing to provide the referral document to their partners, so that the disclosure could be done by service providers rather than by themselves.
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Further, we included the GPs' suspicion of cancer and having noted so in the referral documents.
Both before and after the national introduction of the urgent referral guidelines, patients had a shorter secondary care interval in cases where initial symptoms were categorised as alarm symptoms by the GP or the GP indicated cancer suspicion in the referral documents.
On the other hand, if template-based protocols are ignored only for the patient clinical information to be provided in the form of an unstructured clinical letter, this also runs the risk of defeating the purpose of the standard referral document in the first place.
If someone received a consultation or a diagnosis at a different hospital, we telephoned the hospital and obtained the patient's referral document from the hospital.
Finally, if they could not obtain the patients' referral documents, the diagnosis was coded as "unknown".
For every single contact with a physician the database allows to discern if it took place on the basis of a referral document issued by another physician (the primary care physician in the first place) or not.
If they could not interview either the patients or their family, the psychiatrists relied on the patients' referral documents from other hospitals.
(Interviewee 8-health) One manager wondered if the management team was partly responsible for staff perceiving the SSA as a referral document.
In practice, many professionals were using the SSA as a referral document to secure services for patients.
Instead, its referral document emphasises the barriers, such as the planning system, which prevent other large superstores from entering a local market.
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Since I tried Ludwig back in 2017, I have been constantly using it in both editing and translation. Ever since, I suggest it to my translators at ProSciEditing.

Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com