Quality of GPs' referral letters to diabetes secondary care

Abstract

Good quality referral information enables appropriate triage and the best use of scarce secondary care resources. We evaluated the quality of GPs' referral letters to our district general hospital diabetes centre to identify types of information that receive the highest and the least priority with the objective of developing constructive feedback.Eighty-one letters from 51 GPs, excluding requests for reassessment, emergency inpatient care or non-diabetic concerns, were evaluated on 24 parameters of varying clinical importance and categorised as 'low'(0.0-9.9), 'mid'(10.0-19.9) or 'high' (20.0-30.0) scoring (total 30.0 points).Total scores ranged from 4.5 to 30 (mean 13.3). Mean per cent scores (95% confidence intervals), for selected parameters were: home glucose monitoring 29. Overall, letters were lacking in information regarding surveillance, recognition and management of microangiopathy, blood pressure, body weight, home glucose monitoring and biochemistry. High-scoring letters reflected good insight into the care of people with diabetes.

Impact of referral templates on the quality of referrals from primary to secondary care: a cluster randomised trial

“…Conscientious GPs were therefore likely to score very high on the referral score, and this could bias the results in favour of the intervention. Nonetheless, the scoring system does equate with referral quality measurement scores used in other referral evaluation studies [ 2 , 5 ]. In addition, further work in this project aimes to assess whether the presence of a greater quantity of relevant clinical information improves the quality of the health care process, and consequently this scoring system seemed appropriate.…”

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

“…3 Nevertheless the quality of referral letters has been and remains variable. [4][5][6][7] In one survey 38% of consultants stated that they have been provided with inadequate information by general practitioners ''fairly'' or ''very often''. 8 Nevertheless, much of the criticism of general practitioners' referral letters has been from a secondary care perspective; it is not clear how well they communicate when measured by their own standards.…”

Interventions to Improve the Quality of Outpatient Specialty Referral Requests

“…Change in the completeness of information relayed in a referral request was prespecified as the primary outcome because the main cause of poor quality in referral information is a lack of necessary details. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Additional measures of benefit included change in the accuracy of information relayed and change in the ability to triage the referral request. Measures of potential harm included referring provider satisfaction, which could be negatively impacted if the intervention required increased work by the referring provider, and consultant rated accuracy of triage, which could decrease if the intervention had a negative impact.…”

“…Multiple studies have documented that referral requests rarely contain adequate details to allow triaging to occur, 2-4 potentially resulting in delays in scheduling or unnecessary prioritization. Additionally, information vital to the efficiency of the initial consultation, including details of the patient’s history, 2-16 physical examination, 2-8 and laboratory results, 4-6,16,17 infrequently makes it into referral requests. It has been shown that the problem rarely lies with the specialist not knowing what information he or she needs, 3,18,19 but instead with communicating to the referring provider what information is needed.…”