Emergency referral letters from deputising doctors need to be improvedBMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7041.1304 (Published 18 May 1996) Cite this as: BMJ 1996;312:1304
- John Wright,
- Neeraj Prasad,
- Graham Dalrymple
- Locum, staff grade Department of Accident and Emergency, Royal Alexandra Hospital, Paisley PA2 9PN
- Registrar in cardiology Stobhill Hospital, Glasgow G21 3UW
- General practitioner Abbey Medical Centre, Paisley
EDITOR,—Clearly, the service provided out of hours by general practitioners must be restructured if it is to remain of high quality. Various options are being considered, including cooperatives and overnight medical centres. In their survey Val Lattimer and colleagues found that general practitioners were keen to try these options.1 The new agreement gives doctors the opportunity to transfer their out of hours responsibility to a deputising service.2 This service will still be needed, no matter which options become established. We need, however, to ask whether the deputising service is of sufficient quality to provide out of hours cover.
One way of assessing the quality of the service is to compare the content and quality of emergency referral letters from deputising doctors and general practitioners. Over one month in 1995 five independent observers at the Royal Alexandra Hospital in Paisley were asked to analyse the referral letters for emergency surgical patients; they were not aware that general practitioners were being compared with deputising doctors. Sixty six letters from general practitioners and 50 from deputising doctors were analysed for the presence of points such as the patient's name, age or date of birth, an accurate drug history, and vital signs. Additionally, the number of words in the letters was counted and legibility assessed subjectively (as legible, partially legible, or illegible).
The patient's name was recorded in all of the letters, and age or date of birth was recorded in over 90% in both groups (63 (95%) from general practitioners, 46 (92%) from deputising doctors). At least one vital sign was recorded in 33 (50%) letters from general practitioners and 24 (48%) from deputising doctors. When compared with letters from general practitioners those from deputising doctors tended to be illegible (24 (48%) were assessed as illegible v 9 (14%) from general practitioners, P<0.01); much shorter (30 words v 67 words, P<0.01); less likely to record an accurate drug history (17 (34%) recorded an accurate drug history v 46 (70%), P<0.01); and to be anonymous (38 (76%) v 16 (24%), P<0.01).
Our study indicates that the quality of referral letters from deputising doctors is suboptimal, with three quarters being anonymous, two thirds lacking an accurate drug history, and one half being illegible. Referral letters have a major role in communication between doctors and are an important aspect of quality of care.3 4 This aspect of health care provided by the deputising service needs to be improved.