Take a letter ... an audit of GP referrals in south west Sydney

The overall aim of the study was to examine the quality of communication and the amount of patient information conveyed by general practitioners when referring patients to an emergency department. The study also looked at the prior use of telephone calls made by the referring doctors and ambulance usage for patients referred with a provisional diagnosis of acute coronary or cerebral event.

An audit of the first 998 patients who presented to the Liverpool Hospital emergency department with a referral letter, after initially presenting to their GP, was carried out between June and September 1997. Subgroup analysis was done on referral letters from the patients' own GP compared with another GP. The use of the telephone before sending the patient was also noted. The admitting officer entered patient information on a computerised 'expects screen'. On arrival, the mode of transport was ascertained, in particular, whether an ambulance was used in transporting these patients.

Of 998 consecutive patients with letters, the majority were not referred by the patient's own GP. The number of prior telephone calls to the admitting officer was low. If a patient was sent by their usual GP, a more detailed account of the patient's past medical history, investigations and management was given. In patients with a presumptive diagnosis of 'unstable angina pectoris' or 'acute myocardial infarction', 26% were transferred via ambulance. Only 12.5% were transported by ambulance with a presumptive diagnosis of a cerebral event, 'seizure', 'stroke' or 'CVA'.

For those patients who did present with a referral letter, the standard of information lacked consistency and there was a difference between the content of letter written by their usual GP as opposed to another GP. This study found there was infrequent telephone communication when patients were referred by their GP to the emergency department. This study also shows an under-utilisation of the ambulance service by GPs in south west Sydney when referring patients with coronary ischaemia or a cerebral event to the emergency department.