What's in a referral letter: does the detail matter?

Background: The referral letter is an often-overlooked yet essential element that contributes to the quality of patient care when specialist services are accessed. In the field of maternal-fetal medicine, incomplete referral letters that fail to comprehensively identify pregnancy risk factors can have significant implications for pregnancy management and delivery planning. Objectives: To evaluate the quality and completeness of referral letters from general practitioners and obstetricians to the Fetal Medicine Unit (FMU) at The Canberra Hospital and to improve practice through validation of a patient questionnaire with sensitivity for identifying pregnancy risk factors. Methods: Self reported information from a questionnaire completed by pregnant women presenting for initial consultation to the FMU was compared with information contained in the written referral letter for that particular patient. Information compared was categorised as mandatory referral information, significant past obstetric or gynaecological history, or other relevant medical history. Results: The patient questionnaire was successful in providing clinicians with relevant medical information in addition to that which was contained in professional referrals in 57% (95% confidence interval (CI) 48-67%) of cases. Significantly more risk factors for the current pregnancy were highlighted in the questionnaires than in the referral letters (P = 0.008). Conclusions: A significant proportion of referral letters received by the FMU during the study period lacked completeness in many key areas. Recommendations to improve this situation include the routine use of patient questionnaires or referral letter templates, the development of local referral guidelines, and regular clinician education.