Closing the loop: feedback to accident and emergency SHOs on their referrals to hospital specialists

To determine whether A&E SHOs in the Anglia and Oxford region receive regular case-specific feedback on their referrals to hospital specialists.

A telephone survey of an A&E SHO from each hospital in the region, using a semi-structured questionnaire and written protocol. The main questions asked were: (i) do you receive regular feedback about specific patients you refer to other specialties? If so, which one(s)? and (ii) do you think personal regular case-specific feedback about your referrals would be useful?

Overall, 18 A&E SHOs and one staff grade were interviewed, one from each hospital (response rate 100%). Over the whole region, there were 106 hospital specialties to which A&E SHOs could directly refer out-patient cases. However, regular case-specific communication or feedback was received by the referring A&E SHO from only 5 (4.7%). There were 237 hospital specialties to which A&E SHOs could directly refer in-patients. However, regular case-specific feedback was received by the referring A&E SHO from only 3 specialities (1.3%). The A&E doctors at 18 of the 19 hospitals (95%) felt regular case-specific feedback would be useful. Of these, 13 (72%) would prefer written feedback - 5 (38%) would prefer a copy of the discharge summary or GP clinic letter, 6 (46%) a letter written specifically to the A&E SHO, 1 a letter to be sent via the A&E consultant, and 1 wished for 'any written feedback'. All 18 doctors wanted feedback from at least one of the specialties of general medicine, paediatrics, trauma and orthopaedics, and general surgery.

A&E SHOs in the Anglia and Oxford region do not receive regular case-specific feedback on their referrals to hospital specialists. Almost all A&E SHOs in this study would welcome it. The situation could be rectified by routinely sending them copies of clinic letters or discharge summaries.