Quality of General Practitionersʹ Referral Letters to Emergency Department of Tertiary Care Center in Kosova: Room for Improvement

Background: Referral letters are an essential mode of communication between general practitioners to specialist consultants. Poorly composed letters may result in unnecessary repetition of diagnostic procedures, delays in treatment and increased costs. Aim: To asses the quality of referral letters written by general practitioners to Emergency department of University Clinical Center of Kosova (UCCK) and to seek the views of patients, general practitioners and managers on the importance of referral system. Methods: A random sample of 951 referral letters from general practitioners to Emergency Centre in UCCK, Prishtina were analysed over a one month period (April 15-May 15, 2007). Letters were audit to determine appropriateness of referrals and administrative content. Retrospective analysis of referrals was extracted from Patientsʹ Book conducted at five Main Centers of Family Medicine.Results: Overall 4878 patients were treated in Emergency Centre. Examination of 951 referral letters from Primary ca re revealed that majority of patients came from regions of Prishtina (685/72%) and Mitrovica (130/13.7%). Thirty six percent of referral letters didnʹt meet completely all administrative items. Information that was relatively poorly represented in the letters included referring institutionʹs name (14.7%), doctorsʹ facsimile (5.9%) and patientʹs living place (3.6%). There were 879 consecutive referrals recorded over a one month period from primary care into UCCK. The most common referral diagnoses were related to neuropsychiatric (7.1%), urogenital (4.8%) and cardiovascular diseases (4.7%). Conclusions: The results of this study were used by decision makers for determining new policy of the referral system. Appropriate training of family physicians will increase their knowledge and ability to diagnose and treat a broad range of problems and to improve the level of referral system.