Molloy E, O'Hare J A
Department of Medicine, Mid-Western Regional Hospital, Dooradoyle, Limerick, Ireland.
Ir Med J. 2003 May;96(5):145-6.
Little is known about the process of referral to Irish hospital outpatient medical clinics. We analysed pre-referral management, information quality and communication to a general medical outpatient clinic. 100 consecutive attendee referral letters were prospectively assessed for information, appropriateness, legibility and pre-referral management. Patients underwent a questionnaire. We documented the final diagnosis and management patterns. 16% of letters were largely illegible, Only 47% of letters gave examination findings and of those, 40% omitted significant details. Appropriate pre-referral investigations were performed in 55%. Where performed, results were not enclosed in 32%. In 61% of cases therapy could have been instituted prior to referral, of these treatment was not started in 36%. 16% of patients did not understand the reason for referral. 10% of referrals were inappropriate. In this limited study there were substantial communication deficiencies in patient referral. If standard criteria were set (e.g. by proforma) before a referral is accepted perhaps the quality of patient care might improve especially if treatment could be initiated earlier by referring doctors.
关于爱尔兰医院门诊医疗诊所的转诊流程，人们了解甚少。我们分析了转诊前的管理、信息质量以及与普通内科门诊诊所的沟通情况。对100封连续的就诊者转诊信进行了前瞻性评估，以检查信息、适宜性、清晰度和转诊前管理情况。患者接受了问卷调查。我们记录了最终诊断和管理模式。16%的信件基本难以辨认，只有47%的信件给出了检查结果，其中40%遗漏了重要细节。55%的患者进行了适当的转诊前检查。在进行检查的情况下，32%的检查结果未随信附上。在61%的病例中，转诊前本可开始治疗，其中36%的患者未开始治疗。16%的患者不明白转诊的原因。10%的转诊不合适。在这项有限的研究中，患者转诊存在严重的沟通缺陷。如果在接受转诊前设定标准（如通过格式表单），或许患者护理质量会得到改善，特别是如果转诊医生能更早开始治疗的话。
