Quality of psychiatric referrals to secondary-level care

Objectives. This study examined the quality of referrals to secondary-level outpatient psychiatric services rendered by the Department of Psychiatry, University of the Free State. Referral letters were evaluated according to specific quality criteria. Aspects that would enable secondary-level doctors to make informed decisions in terms of further management and need for special investigations were specifically considered. Design. A descriptive study design was used, and convenience sampling included all referrals to the unit over a 6-month period (June - November 2007). All referral letters were screened according to a checklist designed for this study. Setting. The study was undertaken at the Psychiatry Outpatient Department of the Pelonomi Provincial Hospital in Bloemfontein, which functions as a secondary-level referral centre for mental health in the southern Free State. Outcome measures. Descriptive statistics (percentages, means and standard deviations) were used to summarise results. Results. Two hundred and sixty-three referral letters were included in the study. Less than 20% of the referral letters included information on previous psychiatric consultations, current psychotropic medication, the outcome of physical examinations, and results of special investigations. Only 17 (6%) referral letters indicated a preliminary diagnosis according to an officially recognised classification system. Conclusion. There was conclusive evidence that the quality of referrals to the Psychiatry Department was generally inadequate. A need for more effective referral strategies was identified.