Quality of Referral Letters to the Paediatric Department of a Tertiary Hospital in Nigeria.

Abstract

Background: The referral letter is a flexible means of transmitting information about the care of patients from one healthcare worker to another. In developing regions of the world like Africa, where it may serve as the only means of transferring patient's information, the referral letter has infrequently been studied.

Objective: The study is to assess the quality of referral letters to the Paediatric department of a tertiary hospital in Nigeria.

Methods: Referral letters sent to the Olikoye Ransome-Kuti Emergency Center (ORKCEC) and the Paediatric Outpatient Clinics of the Lagos University Teaching (LUTH) between December 2012 and February 2013 were reviewed for content of information. Letter sent to the emergency center were compared with letter sent from sources within LUTH.

Results: A total of 356 letters were reviewed, with 196 (55.1%) letters sent to the Emergency center. The majority of the referral letters (262; 73.6%) were from hospitals other than LUTH-(inter-hospital). Patient's name (99.7%), name of referring hospital (93.3%) and presenting complaints (91.1%) were the most consistently filled. Information relating to adverse clinical warning (1.7%), request for feedback (4.2%) and urgency of referral (8.4%), were the least filled. Only in 28.4% of the letters were the results of any or all the investigations done included. More interhospital letters had information on findings on physical examination, treatment, urgency of referral and request for feed-back from the receiving specialists. Referral letters to the clinics were more likely than letters to emergency centre to contain information on presenting complaints, history of the presenting complaints, and findings on physical examination.

Conclusion: Referral letters sent to the paediatric department of LUTH are poorly written with significant information about patient care frequently missing. Interhospital referral letters and letters sent to the clinics, though similarly low in quality, were more likely to contain information on physical findings and treatment received.