Doling out too little for priority sake: an audit of referral letters to a tertiary psychiatric unit in Nigeria.
A referral process seeks the assistance of a better or differently resourced facility at the same or higher level to assist in, or to take over the management of the client's case. The referrals received at the psychiatric unit of our tertiary health care facility from across the clinical specialties vary in both quality and content. This study aimed to assess quality of the content and highlight the important elements of 261 referral letters received at the Department of Psychiatry of the Ekiti State University Teaching Hospital (EKSUTH), southwest Nigeria. In the assessment of the letters, a checklist adapted from the University of Manitoba was used carefully to evaluate the quality of each referral letter. More than half, 147 (56.3%), of the letters were received from the adult emergency unit. About a third (31.0%) of the letters had incomplete biodata of the patients; and one out four of the letters did not indicate the reason for the referral. Majority of the referral letters did not give relevant information about patients regarding psychosocial history, clinical findings. About 60% of letters that referred known psychiatric patients gave information on neither previous episodes of psychiatric illness, nor relevant clinical findings. More than a quarter (27.2%) of the referral letters under analysis did not express statement of what was expected, by the referring clinicians, for the patients. Earnest efforts should be made to include the art of medical communication in both undergraduate and postgraduate medical education curriculum.
Key Words: audit, Nigeria, psychiatry, referrals
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