Exploring what constitutes a high-quality referral for a cutaneous complaint: a scoping review of referral components

Referrals are the primary vessel for transferring patient information between primary care clinicians and specialists, providing a snapshot of the patient's condition and the question that ought to be addressed by the consultant. Despite their importance, no guideline currently exists outlining which components should be included in a quality referral for a cutaneous -complaint. This scoping review summarizes the evidence outlining which components might be included in such a referral. The review was conducted in accordance with PRISMA-Scoping Reviews and the Joanna Briggs Institute reporting guidelines. Sources from Embase, Ovid MEDLINE, Web of Science and the Canadian Agency for Drugs and Technologies in Health's Grey Matters database were screened independently and in duplicate. Data from 47 sources published between 1964 and 2023 were charted and synthesized. Results suggest cutaneous referrals should include referral information (e.g. reason for referral, urgency and consultant details), referring clinician information (e.g. name, role, contact information), patient information (e.g. demographics, contact details) and clinical information. Clinical information emphasized the importance of characterizing the lesion or eruption (e.g. anatomical location, size, duration, evolution) and ABCDE (asymmetry, border irregularity, colour variation, diameter > 6 mm, evolving size, shape or shade) criteria for suspected melanoma. If applicable, the referring clinician's impression of the lesion, explicit clinical suspicion of malignancy and high-quality lesion photography were also noted. Relevant medical background, medications, psychosocial history, physical examination and prior investigations and management were highlighted, as were special considerations for inpatient referrals. This scoping review provides a comprehensive list of components for high-quality referrals of cutaneous complaints, addressing a significant gap in medical communication. Standardizing referral components can enhance the quality and efficiency of referrals, ultimately improving patient care with more efficient and accurate triage.