Sometimes system‑wide reform begins with a single, uncomfortable moment.

In mid‑2025, a Children’s Health Queensland Hospital and Health Service (CHQ) paediatrician identified that a general practitioner (GP) had not received an outpatient letter that had been completed, signed and finalised more than seven weeks earlier. The correspondence had been generated using Heidi’s ambient artificial intelligence (AI) scribe, raising an immediate red flag; if a digitally generated, timely, high‑quality letter could still fail to reach a GP, the problem was not individual clinician behaviour—it was the system.

That single missed letter became the catalyst for uncovering a much larger issue—a growing backlog of outpatient correspondence, ultimately affecting up to 20,000 letters and posing a significant clinical risk to safe transfer of care.

Why this mattered to GPs—and patients

For general practice, delayed or missing hospital correspondence is more than an inconvenience. It directly affects continuity of care, medication safety, follow‑up planning and shared decision‑making with families. In this case, the delay prevented timely community‑based care and prompted a GP complaint—an outcome familiar to many clinicians but too often treated as routine.

Importantly, this incident occurred at a time when frontline clinicians were actively adopting digital tools like AI scribes to improve efficiency and letter quality. The failure was not at the point of clinical documentation. It sat downstream—hidden in manual workflows, fragmented systems and limited data visibility.

What we found

Early investigation revealed a perfect storm comprised of:

• a large and growing transcription backlog, worsened by staff attrition
• heavy reliance on manual quality checks, paper handling and postal processes
• inconsistent or missing GP details in the Hospital-Based Corporate Information System (HBCIS), creating downstream distribution failures
• limited system integration—including no automated clinician‑to‑clinician sending at point of sign‑off
• a ‘black hole’ where letters could be generated, signed and then sit unseen without alerting the author or transcriber.

All parties agreed that a months-long delay in outpatient correspondence represented unacceptable clinical risk, particularly for children with complex or time‑sensitive care needs.

A whole‑of‑system response

What followed was a rapid, collaborative response across clinical services, GP liaison, transcription, digital health, health information, administration teams and executive leadership.

In just over 10 weeks, CHQ:

• processed more than 10,000 letters
• reduced turnaround times from 6 weeks to 24–48 hours
• cleared the backlog entirely
• established real‑time visibility through data dashboards
• removed multiple redundant manual steps from transcription and distribution
• doubled transcription productivity while improving letter quality and accuracy.

Crucially, this was not just a numbers exercise. Clear business rules were agreed for who should receive correspondence (and who should not), with a consistent focus on the clinician with ongoing responsibility for the child’s care—usually the GP.

Cultural change matters as much as technology

One of the most important outcomes has been a shift in culture, particularly within administration and correspondence teams. We see a renewed enthusiasm in the administrative team to propose solutions to previously intractable problems.

There is now a shared understanding that clinical correspondence is not an administrative afterthought, but a critical clinical handover, spanning the entire patient journey—from referral, to triage, to outpatient visit and back to the child’s regular GP.

GP Liaison Officers have played a central role, helping bridge clinical, digital and administrative perspectives, keeping the focus firmly on what safe, timely transfer of care looks like in practice.

Aligning with CHQ’s Digital and Data Strategy

This work has since come under the formal oversight of CHQ’s Digital and Data Strategy, aligning with priority programs around integration, automation and cutting through the clutter.

What we did—key enablers included:

• better system integration so platforms talk to each other
• automation of distribution steps once letters are signed
• default inclusion of GPs as recipients, aligned with Specialist Outpatient Services Implementation Standard requirements
• reduction in reliance on paper, scanning and workarounds
• clear governance and ownership of outpatient correspondence performance.

As one digital lead put it: ‘We’ve gone from guessing to knowing; accurate data and streamlined processes mean better care.’

What’s next—and why GPs should care

While the immediate problem has been resolved, the work is far from finished.

From undertaking this work, it is recommended that further reform is needed statewide to:

• properly define the care team within the integrated electronic Medical Record (ieMR)
• enable automated, reliable notifications from Hospital and Health Services (HHSs) to a patient’s regular GP
• embed routine checking and updating of GP and treating team details at every step of the patient journey
• progress the Transfer of Care Information (ToCI) Project beyond discharge summaries into outpatient care
• retire legacy systems like HBCIS, which continue to limit data quality and integration.

For general practice, this work matters. Timely, reliable correspondence is foundational to shared care—particularly for children with complex needs. This initiative demonstrates what is possible when frontline clinicians are heard, when digital teams are empowered to lead change and when the focus remains firmly on patient outcomes rather than process convenience.

Sometimes, all it takes is one missed letter to reveal a system ready for change. The real success is ensuring it never happens again.