Assessment of content quality of referral letters written by Family Physicians in training: a Nigerian tertiary hospital's perspective

Abstract

Background: Referral letters are the major means of communication between primary care physicians and specialists. The information they contain guides specialists in clinical decision making both before and during consultation. The quality of a referral letter reflects its completeness, accuracy, and relevance, and is therefore crucial for appropriate patient prioritisation and the development of effective management plans. In addition, the severity or complexity of a patient's illness may influence the level of detail and thoroughness reflected in the referral letter.
Methods: This study reports the results of a cross-sectional audit that assessed the content quality of 310 referral letters written by family physicians in training. The Consultation and Referral Request Letter Assessment Tool was used to assess the content quality of the referral letters. Patients' illness severity was assessed with the Duke Severity of Illness (DUSOI)/WONCA Checklist. 
Results: Nearly a quarter of the referral letters (23.9%) were rated as helpful and informative, while 15.5% were deemed unhelpful; the majority (60.6%) fell into the fairly informative category. Documentation of relevant comorbidities showed a borderline weak positive correlation with illness severity (rs = 0.111, 95% CI −0.00 to 0.22, p = 0.050), while results of investigations to date showed a weak positive correlation (rs = 0.193, 95% CI 0.08 to 0.30, p = 0.001); the composite content score was not significantly associated with illness severity (rs = 0.069, 95% CI −0.04 to 0.18, p = 0.228). 
Conclusion: These findings call for strategies to improve the content quality of referral letters and ensure consistent transmission of essential information from primary care to specialists, regardless of illness severity.