Measuring the quality of referral letters about patients with upper gastrointestinal symptoms

Abstract

Background General practitioners state the reason for referring patients in referral letters. The paucity of information in these letters has been the source of criticism from specialist colleagues. Objective To invite general practitioners to set standards for referral letters to gastroenterologists and to apply these standards to actual referral letters to one specialist gastroenterology unit. Methods A scoring schedule was designed based on the responses to a questionnaire survey of a large sample of all general practitioners in one locality. Altogether 350 consecutive letters to a district general hospital about patients referred for an upper gastrointestinal specialist opinion were subsequently scored using the schedule. Results 102 practitioners responded to the survey. Their responses imply that colleagues assess and record findings on 18 potential features of upper bowel disease. In practice most referral letters address fewer than six features of upper bowel disease. The mean number of positive features of upper gastrointestinal disease reported in each letter was one. Conclusions This study reported a failure to meet “peer defined” standards for the content of referral letters set by colleagues in one locality. Referral letters serve many purposes, however, encouraging full documentation of specific clinical findings may serve to increase the pre-referral assessments performed in practice.

What's in a referral letter: does the detail matter?

“…It may be possible that there was a subset of the study population who were less likely to consent and take part in the study due to the nature of the referral indication being particularly acute or distressing. The study results of incompletion rates of information in referral letters is however consistent with findings in other areas of medicine 7 , 8 , 9 , 10 .…”

“…This is especially true when it comes to referral letters and the information that they contain 6 . Previous studies in diverse fields of medicine have highlighted problems with referral letters and their content, often finding recipient dissatisfaction and deficiencies of information in key areas 7 , 8 , 9 , 10 . While such previous research has served to identify important issues, relatively few strategies or interventions to improve the quality of referral letters have been studied 2 .…”

Communication in healthcare: a narrative review of the literature and practical recommendations

“…Reasons for the poor content of written communication are also multifactorial: a lack of time to create notes , GPs maybe do not make a full assessment of the problems , GPs and specialists may use a different point of view , they may consider letters to have different goals (e.g. a tool for information transfer vs. archiving) , etc.…”

European panel on the appropriateness of gastrointestinal endoscopy II guidelines help in selecting and prioritizing patients referred to colonoscopy – a quality control study

“…Some studies have suggested guidelines for the specific content of referral letters within different medical specialties (72)(73)(74)(75) and some have shown a beneficial effect of referral templates/form letters on the quality of referral letters (76)(77)(78)(79)(80). Structured templates have also been effective for improving documentation in other medical records, particularly in reports from examinations/procedures (81)(82)(83)(84).…”