A “major overhaul” is needed in the system of referrals for outpatient appointments at Mater Dei hospital, according to a study published in the Malta Medical Journal.

One third of referrals do not have the patient’s past medical or drug history written down and examination findings are not given for one fourth of patients. Moreover, one third of referral tickets used by doctors are partly illegible.

The study lambasts the quality of referral forms as “substandard”, pointing out that such forms were very important as they determined how patients’ details were conveyed – and hence the quality of care.

The study, penned by Matthew Cassar, Janine Mifsud, Daniel Vella Fondacaro and Joseph Debono, examines the quality of the two-page referral tickets to surgical outpatients at Mater Dei Hospital.

The data reveals the inadequacy of the information provided

Most of the patients were referred to the surgical outpatients department by general practitioners (33 per cent), followed by the accident and emergency department (nine per cent) and other specialties (two per cent). However, the source of referral was not clear in over half of the forms (56 per cent).

Moreover, the referral was inappropriate in nearly half the cases (44 per cent), the study notes, pointing out that the majority should have been referred to surgical subspecialties.

Only 69 per cent of all referral tickets were completely legible while 31 per cent were partly legible. None of the forms were completely illegible. Nearly all tickets were handwritten, with only 1.42 per cent of referrals being printed.

The name of the patients’ next of kin was only given in 18 per cent of the referral tickets, while their contact details were only complete in 14 per cent of the cases.

The patients’ history, drug history or allergies and examination findings were available in 69 per cent, 68 per cent and 77 per cent respectively. Only 75 per cent of patients were investigated prior to referral. The patients’ address, contact details, age and gender were available in 95 per cent, 86 per cent, 83 per cent and 89 per cent respectively.

One-third of referrals were partly illegible, the report found. Photo: Shutterstock

Effective communication between primary and secondary care is an integral aspect of the national healthcare system ensuring cost-effective, timely, smooth transition and specialised care for the patient, the study points out. Therefore, referral letters are an essential tool for the management of patients by hospital specialists.

“The data reveals the inadequacy of the information provided to secondary healthcare which potentially impacts on the patients’ quality of care and safety.

“Basic patient details were missing in a significant proportion of patients with some referrals lacking the important unique identification number and also contact details.”

The study highlights the need for a major overhaul in the referral system, with possible improvements being the introduction of electronic referrals and the provision of feedback letters by specialists within secondary care.