Communication across the divide. A trial of structured communication between general practice and emergency...

To evaluate the impact of structured form letters for general practitioner to emergency department (ED) communication.

one hundred and fifty-five GPs with practices in the Liverpool local government area in metropolitan Sydney and patients referred by them to ED at Liverpool over five months from June to October 1998.

randomised control trial of GPs as unit of randomisation; intervention GPs were encouraged to follow a structured proforma for their written communication with the ED. Control GPs were left to usual referral procedures. The ED was encouraged to fax a brief report back to GPs using the form. Impact measures: the quality of the referral letters was evaluated using a checklist that included: reason for referral; examination finding; medical history; investigations; psychosocial history; allergies; drugs given in the surgery and present medication. Surveys were sent every month to GPs to assess communication from the ED and adverse events observed by GPs.

Most letters from GPs to the ED contained information on reasons for referral, medical history and examination findings. Reasons for referral were present in 95% of the intervention group GPs' letters compared with 99% of those of the control group. Investigations were included with 27% and present medications in 37%. Letters from GPs in the intervention group were more likely to contain a psychosocial history than those in the control group (13% compared with 1%). Most GPs reported receiving a letter from the ED although this was rarely by fax; most were brought to them by the patient. Phone calls were received by about one in five GPs each month. Most GPs found both of these to be useful. There were no differences between communication received by GPs in the intervention and control groups.

This study demonstrates that improvements to communication between GPs and EDs are difficult and may require a systemic change within general practice and the hospital. Electronic systems may allow the sort of reciprocal communication required to establish and sustain improvement.