Electronic checklists improve referral letters in gastroenterology: a randomized vignette survey

Abstract

ObjectiveInvestigate whether gastroenterologists rate the quality of referral letters higher if electronic dynamic checklist items are added to a standard free-text referral letter. Assess how this affects the gastroenterologists’ assessment of the patient’s need for healthcare and the agreement between their assessments.DesignRandomized vignette study.SettingNorwegian primary gastroenterology services.ParticipantsThirty-two Norwegian gastroenterologists.InterventionBetween June 2015 and January 2016, participants were recruited through an open invitation to all members of the Norwegian Society of Gastroenterology. They were asked to rate 16 referral letters (vignettes) in a web interface: eight letters in free text following a general template and eight letters based on a general referral template combined with diagnosis-specific checklist items. The study was completed in two subsequent rounds ≥3 months apart.Main Outcome MeasuresQuality of referral letters assessed on a rating scale from 0 to 10. Agreement in the referral assessment and accuracy of the selection of correct preliminary diagnosis and appropriate work-up.ResultsThe mean quality assesses on the rating scale was 7.0 (95% confidence interval [CI] 6.8–7.2) for all letters combined (n = 511), 6.5(CI 6.2–6.8) for the free-text referrals (n = 256) and 7.5(CI 7.3–7.7) for the checklist referrals (n = 255) (P < 0.001, paired t-test). No difference was observed in the triage of the patients, but fewer gastroenterologists felt the need to collect additional information about the patients in the checklist group.ConclusionChecklist items may ease the assessment of the referrals for gastroenterologists. We were not able to show that checklists significantly influence the management of patients.

Assessment of formats and completeness of paper-based referral letters among urban hospitals in Rwanda: a retrospective baseline study

“…Referrals in developing countries are still a burden because they hardly follow any process or procedure at the primary care level which emphasizes the need for improvement that will lead to better quality of care [ 17 , 18 ]. A referral letter is the sole information available regarding the patient on arrival and considerable frustration has been expressed by specialists because they are deprived from relevant quality information content [ 19 ]. Furthermore, there are serious concerns about whether and when to refer a patient for specialized care due to inadequate primary care investigation, which leads to unnecessary and premature referrals and results in ambiguous expectations or adverse outcomes and fragmented care.…”

Essential information for transition of care for frail elderly patients in Japan: A qualitative study

“…To date, many interventions have been performed to assess and improve the quality of the referral process. One approach to improve the quality of referral letters is to use a template that ensures that necessary information is provided in a concise manner 20–22 . However, few studies have been conducted to identify the essential information, especially in the transition of care for frail elderly patients.…”

Essential Information for Transition of Care for Frail Elderly Patients in Japan: A Qualitative Study

“…To date, many interventions have been performed to assess and improve the quality of the referral process. One approach to improve the quality of referral letters is to use a template that ensures that necessary information is provided in a concise manner [20][21][22] . However, few studies have been conducted to identify the essential information, especially in the transition of care for frail elderly patients.…”