Telephoned head injury referrals: the need to improve the quality of information provided

The decision to transfer a patient with a head injury to a neurosurgical department is usually made during a referral telephone call. The referring doctor describes the patient's condition to the neurosurgeon who then decides whether or not the patient needs to be transferred. Failure to inform the neurosurgeon adequately, may result in a disastrous decision to transfer an unstable patient. Alternatively, a patient who needs urgent neurosurgical care may not be transferred. This study assessed the information volunteered by 50 doctors referring head-injured patients. Extra information obtained on request was recorded separately. The referring doctor often failed to provide important information. For example, only 17 doctors volunteered the pulse rate, 16 the blood pressure and six the respiratory rate. Furthermore, the Glasgow Coma Scale was under-used and apparently not understood properly. This may hinder the decision to transfer a patient. A standard referral data sheet is recommended.