• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of qualhcLink to Publisher's site
Qual Health Care. Jun 1993; 2(2): 96–99.
PMCID: PMC1055092

Referral of patients to an anticoagulant clinic: implications for better management.


The quality of anticoagulant treatment of ambulatory patients is affected by the content of referral letters and administrative processes. To assess these influences a method was developed to audit against the hospital standard the referral of patients to one hospital anticoagulant clinic in a prospective study of all (80) new patients referred to the clinic over eight months. Administrative information was provided by the clinic coordinator, and the referral letters were audited by the researchers. Referral letters were not received by the clinic for 10% (8/80) of patients. Among the 72 referral letters received, indication for anticoagulation and anticipated duration of treatment were specified in most (99%, 71 and 81%, 58 respectively), but only 3% (two) to 46% (33) reported other important clinical information (objective investigations, date of starting anticoagulation, current anticoagulant dose, date and result of latest international normalised ratio, whether it should be the anticoagulant clinic that was eventually to stop anticoagulation, patients' other medical problems and concurrent treatment. Twenty two per cent (16/80) of new attenders were unexpected at the anticoagulant clinic. Most patients' case notes were obtained for the appointment (61%, 47/77 beforehand and 30% 23/77 on the day), but case notes were not obtained for 9% (7/77). The authors conclude that health professionals should better appreciate the administrative and organisational influences that affect team work and quality of care. Compliance with a well documented protocol remained below the acceptable standard. The quality of the referral process may be improved by using a more comprehensive and helpful referral form, which has been drawn up, and by educating referring doctors. Measures to increase the efficiency of the administrative process include telephoning the clinic coordinator directly, direct referrals through a computerised referral system, and telephone reminders by haematology office staff to ward staff to ensure availability of the hospital notes. The effect of these changes will be assessed in a repeat audit.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (740K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Charney R, Leddomado E, Rose DN, Fuster V. Anticoagulation clinics and the monitoring of anticoagulant therapy. Int J Cardiol. 1988 Feb;18(2):197–206. [PubMed]
  • Emmanuel J, Walter N. Referrals from general practice to hospital outpatient departments: a strategy for improvement. BMJ. 1989 Sep 16;299(6701):722–724. [PMC free article] [PubMed]
  • Westerman RF, Hull FM, Bezemer PD, Gort G. A study of communication between general practitioners and specialists. Br J Gen Pract. 1990 Nov;40(340):445–449. [PMC free article] [PubMed]
  • Gabbay J, McNicol MC, Spiby J, Davies SC, Layton AJ. What did audit achieve? Lessons from preliminary evaluation of a year's medical audit. BMJ. 1990 Sep 15;301(6751):526–529. [PMC free article] [PubMed]
  • Maclure M, Willett WC. Misinterpretation and misuse of the kappa statistic. Am J Epidemiol. 1987 Aug;126(2):161–169. [PubMed]
  • McInnes GT, Helenglass G. The performance of clinics for outpatient control of anticoagulation. J R Coll Physicians Lond. 1987 Jan;21(1):42–45. [PubMed]
  • Newton J, Eccles M, Hutchinson A. Communication between general practitioners and consultants: what should their letters contain? BMJ. 1992 Mar 28;304(6830):821–824. [PMC free article] [PubMed]
  • Tan G, Cohen H, Taylor F, Gabbay J. Audit of start of anticoagulation treatment in inpatients. J Clin Pathol. 1993 Jan;46(1):67–71. [PMC free article] [PubMed]
  • Berwick DM, Enthoven A, Bunker JP. Quality management in the NHS: the doctor's role--II. BMJ. 1992 Feb 1;304(6822):304–308. [PMC free article] [PubMed]

Articles from Quality in Health Care : QHC are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...