Why doctors do not answer referral letters

Audit of documentation accompanying referred maternity cases to a referral hospital in northern Ghana: a mixed-methods study

Background

Effective referral of maternity cases, which cannot be managed at the primary healthcare level, with detailed referral forms is important for reducing possible delays in the provision of higher-level healthcare. This is the first study to audit documentation or referral forms that accompany referred maternity cases to a referral hospital in the northern region of Ghana.

Materials and methods

This study employed an explanatory sequential mixed-method design, starting with a quantitative review of referral forms that accompanied all patients referred to four units (antenatal, antenatal emergency, labour and neonatal intensive care) of a referral hospital in northern Ghana. In-depth interviews were held with the heads of the four units afterwards. Descriptive statistics were computed for the quantitative data. The qualitative data was subjected to content analysis. Integration of the data occurred at the data interpretation/discussion level.

Results

A total of 217 referral forms were analysed. Nearly half of the cases were referred from the Tamale Metropolis (46.5%) and 83.9% were referred for advanced care, whilst 8.3% were referred due to a lack of medical logistics and equipment such as oxygen and skilled personnel (6%). Completion rates of the referral forms were as follows: < 50% completion (n = 81; 37.3%), 50–75% completion (n = 112; 51.6%) above 75% completion (n = 24; 11.1%). Some of the handwriting were not legible and were quite difficult to read. The key informants stated that incomplete forms sometimes delay treatment. The head of the antenatal care unit at the referral hospital suggested professional development sessions as a strategy for supporting clinicians to fill the forms as expected.

Conclusion

The Ghana Health Service should conduct regular audits, develop job aides and provide incentives for health professionals who accurately complete referral forms. Completing forms and digitizing health records can help ensure further efficiencies in the health information system and sustain good maternity referral documentation practices.

Assessing the quality of referral letters written by general practitioners: a cross-sectional study in rural Iran

Establishing effective communication between general practitioners (GPs) and medical specialists is a key component of the referral system. Written communication between GPs and medical specialists is the most common communication tool. This study was conducted to evaluate quality (information content) of the referral letters written by GPs and addressed to gynecologists and cardiologists. We evaluated quality of the referral letters through a cross-sectional study in the villages of Sarab city, located in East Azerbaijan Province, Northwest Iran. The study was conducted during August and September 2015 in which a total of 400 referral letters were evaluated according to specific quality criteria. Cluster sampling was implemented and data were collected using an instrument designed by the Department of Family Medicine at the University of Manitoba, Canada. A specifically designed referral form was used to refer pregnant women to gynecologists. Referrals addressed to gynecologists showed better quality in comparison to cases referred to cardiologists. Legibility of referral letters was 73%. It is recommended that agreed-upon referral letters be designed cooperatively for different groups of diseases. Furthermore, primary health care providers should be trained to write proper referral letters.

Quality and contents of referral letters from peripheral health centers to the dental centre of a teaching hospital, southwestern Nigeria

OBJECTIVE

Referral letters are deficient in quality and content, which may prevent ideal treatment of patients. Therefore, this study assessed the quality and contents of referral letters from peripheral health centers to the dental center of a teaching hospital in southwestern Nigeria.

MATERIALS AND METHODS

All consecutive referral letters received at the dental center of a teaching hospital in southwestern Nigeria from various peripheral health centers over a period of 1 year were prospectively reviewed using a structured questionnaire. The information extracted were patient's demographic data, addresses of referral persons, dates of referral, reasons for referral, medical and dental history, examination findings, investigations done, diagnosis and treatment given. Descriptive analyses of frequencies were done for all variables.

RESULTS

One hundred and thirty-four referral letters were received and reviewed, comprising letters from 75 (60.0%) males and 59 (40.0%) females. The patient's age ranged from 2-74 years, with a median age of 25 years. The majority, 91 (85.4%), of the letters were written by medical doctors. An appreciable number of referral letters had no name or signature of the referring health care worker. Information on reasons for referral were not available in 27 (20.1%) of the letters. A significant proportion of referral letters lacked vital information on the patient age, past medical history, past dental history, investigations done and treatment given.

CONCLUSION

This study has shown that referral letters written from various peripheral healthcare centers to the dental centre of a teaching hospital is generally of unacceptable quality and the content could be improved upon.