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Objective. The main objective of this paper is to investigate whether incorporating an electronic optional guideline tool (EOGT) in the standardized referral template used by general practitioners (GPs) when referring patients to specialized care can improve outpatient referral appropriateness. Design. Intervention study with an intervention and a control group. Setting. 210 GPs in the municipality of Bergen and the Department of Thoracic Medicine at Haukeland University Hospital. Subjects. 2400 patients referred to the Department of Thoracic Medicine at Haukeland University Hospital. Results. An electronic optional guideline tool (EOGT) was implemented on 93 of 210 GPs' computer systems. The referral quality and the time spent reviewing each referral were evaluated by the hospital specialists. The GPs did not know that their referrals were being evaluated. The specialists were blinded with regard to information concerning the intervention and the control group. The specialists reported significantly higher referral quality and considerably less time spent on evaluating referrals when using the EOGT, with an overall time reduction of 34%. Likewise, GPs also reported that the EOGT was easy to use, time-saving and led to an improved quality of their referrals. Conclusion. This study documents an improvement in the quality of the referrals. Since the GPs save time by using the EOGT, there is no reason to believe that they will discontinue using it. In fact, the tool may be even more beneficial for the GP. The authors believe that it is possible to implement the EOGT as a standard referral tool within various fields of medicine and are currently in the process of developing these tools. [ABSTRACT FROM AUTHOR]