Letters to go: general practitioners' referral letters to an accident and emergency department

OBJECTIVE: To investigate the content of general practitioners' referral letters to the Accident and Emergency (A&E) Department of a large regional hospital. METHOD: Two hundred and fourteen consecutive identifiable letters from general practitioners presented by patients over a four week period were reviewed. The accuracy and content of the letters was measured by the presence of 10 key items, and checked against the A&E notes when necessary. A further nine items were examined to discover whether the context of the referral had any influence on letter content. RESULTS: Information that was relatively poorly represented in the letters included social and personal background details, vital signs, regional examination findings, a management plan, and investigation results. The presence in the letter of a management plan or a clear presenting problem was found to be significantly associated with appropriate referrals. CONCLUSIONS: Poor referral letters may reflect a professional distance between the general practitioner and A&E staff that is stretched by the anonymity of the relationship, increasing A&E specialisation, or lack of feedback to the general practitioner. Specific information standards for A&E referrals should be developed to ease contact and to establish criteria for referral.