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Br J Gen Pract. 2014 Jul;64(624):e419-25. doi: 10.3399/bjgp14X680509.

Impact of referral letters on scheduling of hospital appointments: a randomised control trial.

Author information

1
Department of Medical Education.
2
School of Public Health, Faculty of Health Science.
3
Curtin Health Innovation Research Institute, Curtin University, Perth, Australia.
4
Discipline of General Practice, University of Newcastle, Australia.
5
School of Business, University of Western Sydney, Parramatta, NSW, Australia.

Abstract

BACKGROUND:

Communication is essential for triage, but intervention trials to improve it are scarce. Referral Writer (RW), a referral letter software program, enables documentation of clinical data and extracts relevant patient details from clinical software.

AIM:

To evaluate whether specialists are more confident about scheduling appointments when they receive more information in referral letters.

DESIGN AND SETTING:

Single-blind, parallel-groups, controlled design with a 1:1 randomisation. Australian GPs watched video vignettes virtually.

METHOD:

GPs wrote referral letters after watching vignettes of patients with cancer symptoms. Letter content was scored against a benchmark. The proportions of referral letters triagable by a specialist with confidence, and in which the specialist was confident the patient had potentially life-limiting pathology were determined. Categorical outcomes were tested with χ(2) and continuous outcomes with t-tests. A random-effects logistic model assessed the influence of group randomisation (RW versus control), GP demographics, clinical specialty, and specialist referral assessor on specialist confidence in the information provided.

RESULTS:

The intervention (RW) group referred more patients and scored significantly higher on information relayed (mean difference 21.6 [95% confidence intervals {CI} = 20.1 to 23.2]). There was no difference in the proportion of letters for which specialists were confident they had sufficient information for appointment scheduling (RW 77.7% versus control 80.6%, P = 0.16). In the logistic model, limited agreement among specialists contributed substantially to the observed differences in appointment scheduling (P = 35% [95% CI 16% to 59%]).

CONCLUSION:

In isolation, referral letter templates are unlikely to improve the scheduling of specialist appointments, even when more information is relayed.

KEYWORDS:

decision making; general practice; interdisciplinary correspondence; neoplasms; randomised control trial; referral and consultation

PMID:
24982494
PMCID:
PMC4073727
DOI:
10.3399/bjgp14X680509
[Indexed for MEDLINE]
Free PMC Article

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