title: Impact of referral letters on scheduling of hospital appointments: a randomised control trial.
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.
  
  
  OBJECTIVE
  To evaluate whether specialists are more confident about scheduling appointments when they receive more information in referral letters.
  
  
  METHODS
  Single-blind, parallel-groups, controlled design with a 1:1 randomisation. Australian GPs watched video vignettes virtually.
  
  
  METHODS
  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%]).
  
  
  CONCLUSIONS
  In isolation, referral letter templates are unlikely to improve the scheduling of specialist appointments, even when more information is relayed.
authors: Department of Medical Education.
authors: Moyez
authors: M
authors: Jiwa
authors: School of Public Health, Faculty of Health Science.
authors: Xingqiong
authors: X
authors: Meng
authors: Curtin Health Innovation Research Institute, Curtin University, Perth, Australia.
authors: Carolyn
authors: C
authors: O'Shea
authors: Discipline of General Practice, University of Newcastle, Australia.
authors: Parker
authors: P
authors: Magin
authors: School of Business, University of Western Sydney, Parramatta, NSW, Australia.
authors: Ann
authors: A
authors: Dadich
authors: Department of Medical Education.
authors: Vinita
authors: V
authors: Pillai
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D001315:Australia; D015709:Correspondence as Topic; D005260:Female; D058006:General Practice / Q000379:methods* / Q000592:standards; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008499:Medical Records; D063868:Patient Outcome Assessment; D012017:Referral and Consultation; D016037:Single-Blind Method; D013038:Specialization / Q000592:standards
keywords: decision making; general practice; interdisciplinary correspondence; neoplasms; randomised control trial; referral and consultation