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Analysis of referral letters to a department of old age psychiatry

Published online by Cambridge University Press:  13 June 2014

Fiona Campbell ,
Brian Parsons  and
Ruth Loane
Fiona Campbell
Affiliation:
National Higher Training Scheme in Psychiatry, Ireland
Brian Parsons
Affiliation:
Abraham Cowley Unit, Chertsey, KT16 OAE, UK
Ruth Loane
Affiliation:
Department of Old Age Psychiatry, Mater Hospital, Dublin, Ireland
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Abstract

Objective: There is a paucity of literature on the content of referral letters to psychiatric services and few relating specifically to referrals to a department of old age psychiatry. There has been a significant increase in referrals over the last five years to this service, which may reflect the ageing population and a greater awareness of the service. Our objective was to evaluate the quality and legibility of information received, clarity of reason for referral and details of pre-referral management.

Methodology: The clinical records of the first 100 referrals in 2002 to this department were analysed. The referral letters were examined for the documentation of a number of demographic variables, reason for referral, interventions to date and level of urgency.

Results: The clinical records of nine patients did not have an identifiable referral letter at the time of this analysis. Of the remaining 91 analysed, 59% were referred by their GP, 33% were inpatient liaison referrals and 8% from outpatient departments. In the majority, patients' details were given, however, only 30% included a phone number. Next-of-kin was mentioned in 29%. GP's name was included in 71% of referrals from OPD and 7% of liaison referrals. The level of urgency was stated in 19%. Whether a domiciliary or OPD visit would be more appropriate was stated in 22%. The reason for referral was clear in 75%, with 43% including some aspect of Mental State Examination, 7% had included a MMSE score, 1% mentioned level of suicide risk.

Thirty-one per cent had pre-referral investigations and 45% had pre-referral treatment documented. The letters were clearly legible in 73%.

Conclusion: The information in the referral letter in many cases was insufficient to prioritise and expedite appropriate assessment. It is planned to introduce a proforma referral form, specific to old age psychiatry, which would include the information which is required and which would, hopefully, lead to a more efficient service.

Keywords

ReferralLetterOld agePsychiatry
Type
Audit
Information
Irish Journal of Psychological Medicine , Volume 25 , Issue 1 , March 2008 , pp. 24 - 28
Copyright
Copyright © Cambridge University Press 2008

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References

1.Folstein, ME, McHugh, SE. Mini-Mental State. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 179–188.Google Scholar
2.www.Healthreform.ieGoogle Scholar
3.Molloy, E, O'Hare, JA. Unravelling Referrals to Medical Outpatients. IMJ 2003; 96(5).Google ScholarPubMed
4.www.mentalhealthpolicy.ie/submissions/submission181.pdfGoogle Scholar
5. Central Statistics Office. Census 2002.Google Scholar
6.Raising the standard for older people with mental illness. Report of the Faculty of Old Age Psychiatry. RC Pysch 2006, August.Google Scholar
7.Ward, P, Carvell, J. Referral letters are inadequate. BMJ 1996; 312: 1481.CrossRefGoogle ScholarPubMed
8.Smyth, F, Owens, J, Carey, T. Communication between GPs and psychiatrists. Ir Med J 1994 May-Jun; 87(3): 88–9.Google ScholarPubMed
9.Hodkinson, HM. Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing 1972; 1: 233–8.CrossRefGoogle ScholarPubMed
10.Elwyn, G, Stott, N. Avoidable referrals? Analysis of 170 consecutive referrals to secondary care. BMJ 1994; 309: 576–578.CrossRefGoogle Scholar
11.Teitelbaum, L, Cotton, D, Ginsbury, ML, Nashed, YH. Psychogeriatric Consultation Services: Effect and Effectiveness. Can J Psychiatry 1996; 41: 638–644.CrossRefGoogle ScholarPubMed
12.O'Neill, C, O'Connell, H, Lawlor, BA. Psychiatric consultation to elderly medical inpatients in a general hospital. Ir J Psych Med 2003; 20(3): 80–83.CrossRefGoogle ScholarPubMed
13.Mainprize, E, Rabin, G. Geriatric referrals to a psychiatric consultation-liaison service. Can J Psych 1987; 32; 5–9.CrossRefGoogle ScholarPubMed
14.Chambers, D, Callaghan, A. National Suicide Review Group (Ireland), Annual Report 2003.Google Scholar
15.Charatan, FB. Elderly in US have rising suicide risk. Br Med J 1996; 312: 144. Department of Health (1996) National Task Force on Suicide: Interim Report. Dublin: Government Publications, 1996.CrossRefGoogle ScholarPubMed
16.Kirby, D. Ames, D. Hyponatremia and selective serotonin re-uptake inhibitors elderly patients. Int J Geriatr Psychiatry 2001 May; 16(5): 484–93.CrossRefGoogle ScholarPubMed
17.Moore, AR, O'Keeffe, ST. Drug-induced cognitive impairment in the elderly. Drugs Aging 1999 Jul; 15(1): 15–28.CrossRefGoogle ScholarPubMed
18.Tune, LE. J Clin Psychiatry 2001; 62 (Suppl 21): 11–4.Google Scholar
19.Wrigley, M, Loane, R. Consultation-Liaison referrals to the north Dublin old age psychiatry service. IMJ 1991:84(3).Google Scholar
20.Audit Commission. Forget Me Not: Mental Health Services for Older People. London: Audit Commission, 2000.Google Scholar
21.Fertig, A, Roland, M, King, H, Moore, T. Understanding variation in rates of referral among general practitioners: are inappropriate referrals important and would guidelines help reduce rates? BMJ 1993; 307: 1467–70.CrossRefGoogle ScholarPubMed
22.Leonard, I, Babbs, C, Creed, F. Psychiatric referrals within the hospital-the communication process. J R Soc Med 1990 Apr; 83(4): 241–244.CrossRefGoogle ScholarPubMed