A retrospective audit of referral letter quality from general practice to an inner‐city emergency department

Abstract

Referral quality was influenced by letter format but not by urgency of the patient's condition. Omission of information from referral letters potentially risks patient safety. Handwritten referrals should be abandoned. Comprehensive electronic letter templates and regular updating of medications, comorbidities and allergies are encouraged.

Improving quality of referral letters from primary to secondary care: a literature review and discussion paper

“…This was a self-report design and consequently, the results are subject to recall bias. The survey was conducted online and it is possible that participants that were more IT savvy would be more inclined to respond to the web-based questionnaires Nash et al (2016)…”

“…Studies varied in methodologies: 12 studies were quantitative, four were qualitative and two studies used a mixed methods approach. Study limitations included having a small sample size (Jiwa and Dhaliwal, 2012;Corwin and Bolter, 2014), and being limited to a single region or health service network (Shaw and de Berker, 2007;Evans, 2009;Hysong et al, 2011;Rokstad et al, 2013;Wahlberg et al, 2015;Zuchowski et al, 2015;Nash et al, 2016), and consequently, the findings may not be generalisable and relevant to other health systems. Some of the studies involved only PCPs as participants, whereas the involvement of specialists would have been useful for triangulation (Xiang et al, 2013;Eskeland et al, 2017).…”

“…A study of referrals using templates from nine primary care practices to nephrology clinics (2007) 3 ERs showed communication of the patient's problem by GPs was poor Kim et al (2009) 4 72% believed that ERs improved overall clinical care of patients but the study population was a mixture of physicians, many were specialists and the study setting is not representative of typical general practice Nash et al (2016) 3 ERs provided more clinical information than handwritten but no effect on patient or system outcomes Hysong et al (2011) NA Improvement in referral coordination by PCPs and subspecialists Zuchowski et al (2015) NA Improvement in referral communication…”

Referrals from primary care to community mental health teams: what’s missing?

“…For the last 30 years, the literature has been consistent in acknowledging the variability in content and quality of referrals from primary care to specialist services, for both physical and mental health concerns. [10][11][12][13][14][15][16][17] Information contained in referrals falls into two categories: administrative and clinical. Previous studies note that most referrals contain adequate administrative details, allowing recipient services to process them.…”

“…Risk information and rating of urgency (despite there being clinical disagreement between referrers and specialists) have been identified as important in assisting triage and allocation processes. 14,17 The referred person's physical health history is more likely to be missed in psychiatric than in other referrals. Finally, a case history is important regardless of whether referral is for physical or mental health, but is likely to incorporate slightly different indicators such as allergies, family history of disease, comorbid health conditions for physical health and family history of suicide or mental illness, alcohol and substance use for mental health services.…”