Write2me: using patient feedback to improve postconsultation urology clinic letters

Letters between hospital clinicians and general practitioners following an outpatient clinic (OPD) consultation have generally not been shared with patients. Recent guidelines from the Academy of Medical Royal Colleges recommend that all OPD letters should be written directly to the patient. While the benefits of this approach are recognised, additional attention is required to ensure readability, accuracy and acceptability. Our aim was to improve urology OPD letters in a university teaching hospital to ensure suitability for sharing with patients over a 3-month period as measured by patient feedback. In one OPD, 71% of patients stated that they wished to receive a copy of their letter. We designed, tested and implemented two paper-based, self-explanatory prompts to ensure doctors used paragraphs and a structured letter format when dictating OPD letters. This was achieved using a 90-day improvement cycle supported by a quality improvement learning collaborative and evaluated by measurement of Flesch Reading Ease Score, use of paragraphs, use of letter structure and patient feedback. Following the implementation of the intervention, letters were sent to 120 patients and feedback was obtained from 63 patients with either a feedback postcard or telephone interview. Of the 53 patients who agreed to participate in the telephone feedback, 39 (74%) found the letter easy to understand, 49 (92%) reported it was accurate and summarised the consultation as they remembered it and 38 (72%) reported that reading the letter improved their understanding of their OPD visit. All patients said they would like to receive similar letters from future OPD consultations. This improvement report describes the implementation of an intervention to improve the quality of OPD letters and the acceptability and value of these letters to patients.