Communication between Primary and Secondary Care Physicians: An Evaluation of Referral and Discharge Letters

Background:. Accurate transfer of patient information in referral and discharge letters enables better communication between primary and secondary care and patient outcomes. Objective: To evaluate the quality and content of... [ view full abstract ]

Background:. Accurate transfer of patient information in referral and discharge letters enables better communication between primary and secondary care and patient outcomes.

Objective: To evaluate the quality and content of referral and discharge letters using patients’ medical records in an Irish general practice setting.

Methods: All general practices affiliated with the University of Limerick Graduate Entry Medical School (GEMS) (n=72 practices) were invited to participate. Medical students on placement used practice software functions to generate a random sample of 100 adults aged over 50 years to examine consults between 2013-2015. The content of referral letters from general practices and hospital discharge letters were evaluated against current national guidelines. Data from participating practices was collated and descriptive statistics were performed. Ethical approval for the study was granted from the Irish College of General Practitioners Research Ethics Committee.

Results: A total of 70 clinical practices participated in the study. Data from 3348 referral letters and 2468 discharge letters were analysed. Most referral letters included the reason for referral 3262 (97.4%), history of complaint 3005 (89.8%) and examination findings 2648 (79.1%). The most frequently omitted data in referral letters related to the primary care management up to the point of referral 2180 (65.1%). Evaluation of discharge letters revealed that information pertaining to the hospital course, such as investigations 1806 (73.3%), results 1729 (70.0%) and follow-up plan 2093 (84.8%) were generally included. Omissions in discharge letters related to medication changes 746 (30.2%) and medication lists 810 (32.8%).

Conclusion: Most essential patient information was included in referral and discharge letters. The categories of data most likely to be omitted in both referral and discharge letters related to therapeutic management and medications.