[Referral letters to the pediatric emergency department]

Referral letters to pediatric emergency departments (ED) may be an important source of information available to the emergency department staff. This mode of communication has been subject to relatively few studies.

Our objective was to canvass the expectations of ED physicians from referral letters and contrast these expectations with the actual content of referral letters.

A questionnaire containing different items of information that may appear in referral letters was distributed to ED pediatricians. The physicians scored these items and were asked to add other items that should, in their opinion, appear in referral letters. Scores given to the items ranged from "not important" (score = 1) to "very important" (score = 5). Information regarding the physician's experience in the field of pediatrics was obtained. Subsequently, sequential referral letters were collected from a pediatric ER. These letters were analyzed with respect to the items scored in the first part of the study. Letters were stratified to handwritten and form letters, and by language.

A total of 21 physicians participated in the study. The mostly valued pieces of information were clinical information (principal complaint, physical examination prior to referral, past medical history) as well as demographic data and information regarding the referring physician. Lower scores were given to items regarding socioeconomic background of the patient, immunizations and tentative diagnosis. A total of 299 letters were collected. Items missing in more than 50 percent of letters were: socioeconomic background, family medical history, allergies, immunizations, current medications, referring physician's phone number, past medical history. Form letters contained more information than handwritten letters.

Referral letters to pediatric ED's do not live up to the expectations of the receiving physicians. Specific expectations from, and shortcomings of letters may be pinpointed and addressed.