Helge Garåsen The Trondheim Model - NSDM

4.1.2 Assessments of outcomes
There are several international studies assessing written communication between physicians.
Some earlier studies have assessed the quality of referral letters using questionnaires
(64,70,73) or by audits (69). A Delphi survey with expert panels in a particular area of interest
has been widely utilized in other fields in clinical medicine and health care services (36-
38,118). It has proved to be an effective and reliable method in developing reliable judgments
and criteria of quality guidelines (36-37).
4.1.2.1 Quality of referral and discharge letters
Referral letters from general practitioners to secondary care record the reasons for requesting
a specialist consultation or care at a general hospital. Ideally the referral letters should provide
sufficient information to enable decisions to be made about appropriate care and which
patients should be prioritised to inpatient or outpatient care. Most critiques of referral letters
have been from specialists assessing the referrals from a secondary care perspective, but even
in a study where general practitioners evaluated other general practitioners’ referral letters,
quality was considered to be low (69). There are also several studies (70-76) describing the
insufficient quality of discharge letters even when the content of the referral and discharge
letters had been agreed between physicians beforehand (64-65).
However, there have been few discussions between different health professions about whom
and what the letters should address:
- Is it a letter from one physician to another, for medical diagnosing and treatment of an
illness (“cure”) just describing the most relevant medical facts surrounding the
patients’ situation?
- Is it a letter from a team of professionals to another describing the patient’s disease(s)
and the consequences of the disease(s) for the patient?
- Is it a letter that allows the recipients to optimise the patients’ need for care in a
broader social context including the patients’ ADL?
- Is it a letter summarising what one professional or a team has done of actual
diagnosing and care, functioning as a report and summary of the health journal, i.e.
acting as a document fulfilling legal demands set by the health authorities?
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