Standardizing the Referral Letter to Improve Care

Brianne N. Hobbs, OD


April 14, 2014

In This Article

Assessment of the Quality of Glaucoma Referral Letters Based on a Survey of Glaucoma Specialists and a Glaucoma Guideline

Cheng J, Beltran-Agullo L, Trope GE, Buys YM
Ophthalmology. 2014;121:126-133

What We Have Here Is a Failure to Communicate

"Man is fallible, but maybe men are less so."

This quote, by Atul Gawande in The Checklist Manifesto: How to Get Things Right, emphasizes the importance of communication and collaboration in medicine. One such type of necessary communication in medicine is the referral letter, which serves as an important link in the continuity of care. In a recent survey conducted by a major medical association, almost half of respondents felt that the referral process was ineffective.[1] Another study, conducted in London, found that 44% of referral letters omitted one or more important findings, and only 7% of referral letters were judged to be "ideal."[2]

A lack of communication between providers can have a detrimental effect on the care that patients receive. Although many referral letters are exchanged between providers, often there is no clear format or guideline to standardize the process, thus leaving the contents and structure up to the individual provider. This creates a large amount of variability in the quality and utility of referral letters. Specialists may prefer specific findings or elements of the patient history to be included, which a provider may inadvertently omit if that provider is not aware of the desires of the specialist. Interruptions in the referral process also leave providers open to litigation if the proper follow-up does not occur. Open and efficient communication between the referring provider and the specialist can improve the quality of referral letters.


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