Evaluation of the Pattern and Quality of Referrals from Inpatient Wards to Hematology Department of a Tertiary Hospital in Nigeria

Abstract

Background: The overall quality of care may be hampered by poorly written referrals. Referral letters should be detailed to elicit prompt response by the invited unit. This will enhance ideal management of cases that are referred.

Aim: The aim of the study is to determine the quality (content and usefulness) of referral letters received from inpatient clinical wards of University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla by hematology department of the hospital.

Materials and Methods: This was a retrospective study of all referral letters received in hematology department of the hospital over a 1‑year period (January to December, 2019) using a validated questionnaire.

Results: A total of 231 referral letters were received and evaluated. The median age of the patients was 35 (range: 20–59) years with male‑to‑female ratio of 1:1.3. Initial statement identifying the reason for the referral was observed in 88.7% (n = 205). Majority (176/213, 82.5%) of the referrals did not include the results of investigations the patients did before the referral. Less than a quarter of the referrals (41/231, 19.3%) contained information on the treatment given to the patient. More than one‑tenth (24/231), 11.3%) of the referrals were unhelpful while 13.6% (n = 29) were helpful.

Conclusion: The referrals sent to the hematology department were deficient in quality. These deficiencies could be ameliorated by tutoring the younger doctors on the content of an ideal referral letter. Furthermore, a well‑structured “referral form” with prompts for easy filling could be designed by hospitals as a guide to physicians for writing appropriate referral letter.