Referral for 'prostatism': developing a 'performance indicator' for the threshold between primary and secondary care?

Area of Science:

• Urology
• Healthcare Management
• Clinical Informatics

Background:

• Primary and secondary care interfaces are crucial for efficient patient management.
• Referral letters are key communication tools between general practitioners (GPs) and specialists.
• Standardizing referral information can improve diagnostic accuracy and patient flow.

Purpose of the Study:

• To establish a performance indicator for the gateway between primary and secondary care in urology.
• To assess the information content of referral letters sent to a urological department.
• To identify deficiencies in referral practices that impact specialist assessment.

Main Methods:

• Analysis of 221 sequential referral letters from GPs to a urology department at a teaching hospital in Cardiff, Wales.
• Stratification of referral letters into categories based on the inclusion of history, examination findings, routine investigations, and specialized investigations.
• Evaluation of the completeness of information provided for the assessment of patients with prostatism.

Main Results:

• Three categories of referral practices were identified based on information provided.
• Over a third of GPs (36%) failed to include adequate information in referrals for prostatism.
• Less than 4% of referrals included detailed urological investigations like urinary flow rates or post-micturition residual urine volume.

Conclusions:

• The majority of referrals (60%) contain sufficient information for specialist prioritization.
• A significant portion of referrals (36%) are inadequate, hindering efficient specialist appointment scheduling.
• The developed method shows potential as a gateway performance indicator for clinical practice in urology.