Poor quality of referral from mental to somatic hospitals

Concomitant somatic and mental illness is associated with excess mortality compared with the general population. To prevent this, a number of health initiatives relating to somatic illness in psychiatric patients have recently been introduced. One of the means used to screen for and treat somatic disease in psychiatric patients is highly qualified referral for somatic specialist assessment. The aim of this study was to assess the quality of referral of psychiatric patients to specialists in internal medicine.

A total of 110 consecutive referrals were collected from August to November in 2012 and 2013. Regional guidelines define the requirement for the satisfactory referral scheme and using these guidelines as a reference, each referral was rated based on indexation and an overall assessment. A report about the 2012 results was presented to the hospital management. The management of the hospital was not informed about the 2013 replication of the study.

Half of the topics assessed were inadequately completed. Information about somatic co-morbidity was missing in 76% of the referrals. Description of relevant tests and physical examinations was missing in 53%. By overall assessment, 40% of the referrals were rated as being insufficient. The resident physicians stand out by producing the most informative referrals. The 2013 results improved compared with 2012.

We call for improvement in the quality of the referrals among psychiatric in-patients to somatic specialists. We propose an expansion of the use of standardised schemes and a strengthening of the skills needed to write a good referral.