Examining the quality of referral letters to an ENT department – An audit

Introduction: Effective communication between medical professionals is the cornerstone in a safe medical practice. A breakdown in communication can have a catastrophic systemic effect on patientcare and treatment outcomes. We assessed the quality of referral letters written by staff under various settings in this audit.
Methods: An audit on referral letter quality was carried out on 228 consecutive first referrals (red numbers) seen at the ENT clinic in the outpatient department (OPD) at the Army Hospital Colombo (AHCBO), during the months of February and March 2024. All referrals were seen by a single ENT consultant.
Results: When we analyse the quality of the referrals, the overall quality of referrals was average (58.67%) with a score of 3.51 out of 6. The majority of the referrals were made from the outpatient department (72.81%) and consisted of mainly consultant referrals (48.25%) through a hand written medium (80.7%). The majority of the referrals were regarding ear related pathologies (59.65%). The overall quality of referrals made via the electronic referral system of the hospital were better than the traditional hand written variety, referrals made by consultants were better than medical officers but, medical officers surpassed consultants when they used the AHIS.
Conclusions and Recommendations: The quality of medical referrals received to an ENT clinic of the OPD department on average scored only 58% (3.51 of 6) which is average but surprisingly similar to other studies done in the past internationally. Using a hospital-based information system like AHIS improves overall referral letter quality. Consultants’ letters overall are of better quality than letters from medical officers, however, medical officers letter quality improved with their usage of AHIS to a level better than of consultants. Overall, if consultants were to train on the AHIS in letter writing their performance could be improved to reflect in the next audit cycle.