title: What is the importance of the referral letter in the patient journey? A pilot survey in Western Australia.
abstract: BACKGROUND
  Access to specialists is mediated by general practitioners in many countries. In these settings, specialists rely on information in referral letters when deciding which cases to schedule for their clinics.
  
  
  METHODS
  Two-hundred and seven consecutive referral letters to gastroenterologists were scored for the amount of information relayed to the specialist, using a published schedule. The 'quality' scores for these referral letters were compared for four groups of patients: patients diagnosed with histological lesion, those with no histological lesion, those who failed to attend clinic, or those who had a diagnosis unknown. Forty-two referral letters were generated with a range of quality scores. Four gastroenterologists were asked to identify which letters described patients 'likely' to have a significant or benign colorectal condition, and whether they could triage the cases for their clinic given only the information in the letters.
  
  
  RESULTS
  It was not possible to differentiate which letters related to patients in each of the four categories (P = 0.6). Patients who failed to attend were more symptomatic than those with a histological lesion (35.4 versus 28.2, mean difference 7.14, 95% confidence interval (CI) 14.1 to 0.15, P = 0.045). Patients referred 'urgently' were not, on the basis of the referral letters, the most symptomatic group (29.7 versus 27, mean difference 2.7, 95% CI -3.4 to 8.8, P = 0.38). The specialists failed to agree on the proportion of cases that could be triaged for their clinics. The cases that could be triaged contained more information (mean 66.38 versus 49.86, mean difference 16, 95% CI 1.3-31.7, P < 0.001).
  
  
  CONCLUSIONS
  There was no evidence for an association between the amount of information relayed and the diagnosis of a histological lesion. However, more information was helpful when deciding which patients to schedule first. By corollary, patients referred with lesser documentation of their clinical presentation may be denied 'urgent' access to the gastroenterology clinic.
authors.affiliation: Curtin Health Innovation Reseach Institute, Curtin University of Technology, Perth, Australia. m.jiwa@curtin.edu.au
authors.forename: Moyez
authors.initials: M
authors.lastname: Jiwa
authors.forename: Hayley
authors.initials: H
authors.lastname: Arnet
authors.forename: Max
authors.initials: M
authors.lastname: Bulsara
authors.forename: Hooi C
authors.initials: HC
authors.lastname: Ee
authors.forename: Abby
authors.initials: A
authors.lastname: Harwood
mesh_terms: D015709:Correspondence as Topic; D004066:Digestive System Diseases / Q000175:diagnosis; D005194:Family Practice / Q000379:methods / Q000458:organization & administration*; D005762:Gastroenterology; D006801:Humans; D007400:Interprofessional Relations; D010043:Outcome and Process Assessment, Health Care; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D014218:Triage; D014904:Western Australia