Jenkins R M
Br J Gen Pract. 1993 Mar;43(368):111-3.
Thirty eight specialists in one district health authority were asked to take part in a questionnaire survey to assess the appropriateness of referral and the quality of the referral letter for 20 consecutive new patients each. A total of 705 new patient referrals to 13 specialties were included in the study. Twelve of the 38 specialists were randomly selected and their 234 new patient referral letters were independently assessed by a general practitioner for the appropriateness of the referral decision. The study revealed errors and omissions in between 5% and 28% of referral letters according to the category of information. Thirteen per cent of the new patient referrals were assessed by specialists to be inappropriate and 4% of patients had been referred to an inappropriate specialty. Significantly more of the referrals to medical specialties were inappropriate (20%) than to surgical specialties (9%) (P < 0.01). There were more than three times the number of errors and omissions in the referral letters of referrals assessed as inappropriate than in the referral letters of referrals assessed as appropriate (P < 0.01). The referral letters of referrals assessed as inappropriate were more than nine times as likely to omit the reasons for or objectives of the referral compared with letters for those referrals assessed as appropriate (P < 0.01). There was a good overall agreement between the specialists and general practitioner in their assessment of the appropriateness of the clinical referrals (kappa = 0.614, P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
一个地区卫生当局的38名专家被要求参与一项问卷调查，以评估每位专家连续20位新患者的转诊适宜性及转诊信质量。该研究共纳入了向13个专科转诊的705例新患者。从38名专家中随机选取12名，其234封新患者转诊信由一名全科医生独立评估转诊决定的适宜性。研究显示，根据信息类别，转诊信中存在5%至28%的错误和遗漏。专家评估认为13%的新患者转诊不合适，4%的患者被转诊到了不适当的专科。内科专科的转诊不合适比例（20%）显著高于外科专科（9%）（P<0.01）。被评估为不合适的转诊信中的错误和遗漏数量是被评估为合适的转诊信的三倍多（P<0.01）。与被评估为合适的转诊信相比，被评估为不合适的转诊信遗漏转诊原因或目的的可能性高出九倍多（P<0.01）。专家和全科医生在评估临床转诊适宜性方面总体一致性良好（kappa=0.614，P<0.001）。（摘要截断于250字）
