Contemporary referral of patients from community care to cardiology lack diagnostic and clinical detail

Abstract

The quantity of referrals to secondary care is increasing. That the quality of medical referrals is decreasing is a common allegation yet has rarely been assessed. We report a time-limited, cross-sectional survey evaluating cardiological referral information quality. Referral letters (n = 218, excluding direct access pro formas) from GPs to the Cardiology Department at City Hospital, Birmingham, were collated and analysed over 2 months. A subset (n = 49) of these patients completed questionnaires assessing their knowledge and patient communication of the referral. Information quality was poor (length, diagnosis, expectation, prior treatment and investigation) with almost half of all letters containing only outline symptomatic complaints without diagnosis. The majority of patients referred had not been investigated or treated in any way before referral. Despite lack of understanding of the reason for referral, typically the majority of patients expressed themselves as satisfied with the process. Given most referrals are seen as appropriate, information exchange between secondary and primary care is crucial. By contrast, the standard of even basic clinical assessment communicated between primary care and secondary care was severely limited. The reason(s) why medical assessment is lacking are unclear but must be explored to give more support to primary care to complete basic medical task particularly if investment is to flow into this source.

Impact of referral templates on patient experience of the referral and care process: a cluster randomised trial

“…It is therefore possible that the effect of the intervention on patient experience could have been higher if the level of dissatisfaction with the healthcare cooperation had been higher in the local population. However, this also may suggest that although the hospital consultants often feel information is lacking in the referrals,38 39 this is not necessarily experienced as a problem by patients.…”

Smoothing the passage of patients from primary care to specialist respiratory opinion

“…10 The absence of previous investigation results was noted in more than 50% of the referral letters in three separate studies, 3,22,24 patients' medical history was not routinely included in referral information, 13,16,25 and allergies 16,23 and clinical findings 5,17,18,22 were generally poorly recorded. These omissions may be due in part to the fact that there is no real consensus amongst different specialties on the ideal information to be included in a referral letter, beyond an agreement on broad information categories.…”

“…Therefore, we undertook a detailed literature review of studies analysing the content of GP referral letters. Twenty-four studies were identified, covering a wide range of specialties [1][2][3][4][5][6][7] and different referral systems. [8][9][10] Several evaluated the impact of guidelines [11][12][13][14] or use of structured referral forms 15,16 on referral information.…”

The effect of referral templates on out-patient quality of care in a hospital setting: a cluster randomized controlled trial

“…To assure high quality further down in the treatment process, the referral letter from the GP should contain all the necessary information in a context of shared understanding among the GP, the patient, and hospital staff [27]. However, a number of publications have pointed to the varying quality and content of referrals in clinical practice [28–30]. Over the years, many interventions have been directed at the referral process.…”