Clinical audit of medical referral notes at Bangladesh Medical University Hospital
DOI:
https://doi.org/10.3329/bsmmuj.v18i3.83627Keywords:
clinical audit, medical referral notes, healthcare communication, quality improvement, interdisciplinary careAbstract
Background: Medical referral notes are essential for smooth patient care transitions between healthcare providers. Poorly organised or incomplete referrals can cause delays in treatment, miscommunication, and risk to the patients. This clinical audit assessed the quality of medical referral notes at Bangladesh Medical University (BMU) Hospital regarding their compliance with established standards.
Method: A cross-sectional study was carried out on 113 referral notes gathered from various departments in April 2025. Eight audit standards were adapted from BMU's existing referral notes. Trained auditers collected the completed referral notes and extracted data from the notes.
Result: About seven in ten (71.7%) of referral notes had date and time written properly. Most referrals (81.4%) were sent to faculty members, 65.5% having clear justification and 46.9% having full clinical information. About six in ten (58.4%) responded timely with proper explanations (61.1%), and a follow-up plan (65.5%). The study revealed considerable deficiencies. Overall, 46.9% of them met all required standards.
Conclusion: More than half of the referral notes did not meet the required standards. We recommend the introduction of an electronic referral system with a provision of periodic audits to maximise healthcare quality.
Downloads
70
16 PDF
14 Review report
10 Supplementary file
13
References
Johnston G, Crombie IK, Davies HT, Alder EM, Millard A. Reviewing audit: barriers and facilitating factors for effective clinical audit. Qual Health Care. 2000;9(1):23-36. doi: https//doi.org/10.1136/qhc.9.1.23
O’Donnell CA. Variation in GP referral rates: what can we learn from the literature? Fam Pract. 2000;17(6):462-471. doi: https//doi.org/10.1093/fampra/17.6.462
Akbari A, Mayhew A, Al-Alawi MA, et al. Interventions to improve outpatient referrals from primary care to secondary care. Cochrane Database Syst Rev. 2008;(4):CD005471. doi: https//doi.org/10.1002/14651858.CD005471.pub2
Newton J, Eccles M, Hutchinson A. Communication between general practitioners and consultants: what should their letters contain? BMJ. 1992;304(6830):821-824. doi: https//doi.org/10.1136/bmj.304.6830.821
Kinchen KS, Cooper LA, Levine D, Wang NY, Powe NR. Referral of patients to specialists: factors affecting choice of specialist by primary care physicians. Ann Fam Med. 2004;2(3):245-252. doi: https//doi.org/10.1370/afm.68
Gandhi TK, Sittig DF, Franklin M, Sussman AJ, Fairchild DG, Bates DW. Communication breakdown in the outpatient referral process. J Gen Intern Med. 2000;15(9):626-631. doi: https//doi.org/10.1046/j.1525-1497.2000.91119.x
Jiwa M, Skinner P, Coker AO, Shaw L, Campbell MJ, Thompson J. Implementing referral guidelines: lessons from a negative outcome cluster randomised factorial trial in general practice. BMC Fam Pract. 2006;7:65. doi: https//doi.org/10.1186/1471-2296-7-65
Forrest CB, Glade GB, Baker AE, Bocian A, von Schrader S, Starfield B. Coordination of specialty referrals and physician satisfaction with referral care. Arch Pediatr Adolesc Med. 2000;154(5):499-506. doi: https//doi.org/10.1001/archpedi.154.5.499
Kinfu Y, Dal Poz MR, Mercer H, Evans DB. The health worker shortage in Africa: are enough physicians and nurses being trained? Bull World Health Organ. 2009;87(3):225-230. doi: https//doi.org/10.2471/BLT.08.051599
Dussault G, Franceschini MC. Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce. Hum Resour Health. 2006;4:12. doi: https//doi.org/10.1186/1478-4491-4-12
Roland M, Rao SR, Sibbald B, Hann M, Harrison S, Walter A, Guthrie B, Desroches C, Ferris TG, Campbell EG. Professional values and reported behaviours of doctors in the USA and UK: quantitative survey. BMJ Qual Saf. 2011 Jun;20(6):515-521. doi: https//doi.org/10.1136/bmjqs.2010.048173
Jamtvedt G, Young JM, Kristoffersen DT, O’Brien MA, Oxman AD. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2006;(2):CD000259. doi: https//doi.org/10.1002/14651858.CD000259.pub2
Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O'Brien MA, Johansen M, Grimshaw J, Oxman AD. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012 Jun 13;2012(6):CD000259. doi: 10.1002/14651858.CD000259.pub3. Update in: Cochrane Database Syst Rev. 2025 Mar 25;3:CD000259. doi: https//doi.org/10.1002/14651858.CD000259.pub3
Pronovost PJ, Nolan T, Zeger S, Miller M, Rubin H. How can clinicians measure safety and quality in acute care? Lancet. 2004 Mar 27;363(9414):1061-1067. doi: https//doi.org/10.1016/S0140-6736(04)15843-1
Wright J, Dugdale B, Hammond I, Jarman B, Neary M, Newton D, Patterson C, Russon L, Stanley P, Stephens R, Warren E. Learning from death: a hospital mortality reduction programme. J R Soc Med. 2006 Jun;99(6):303-308. doi: https//doi.org/10.1258/jrsm.99.6.303
Lau R, Stevenson F, Ong BN, Dziedzic K, Treweek S, Eldridge S, Everitt H, Kennedy A, Qureshi N, Rogers A, Peacock R, Murray E. Achieving change in primary care-effectiveness of strategies for improving implementation of complex interventions: systematic review of reviews. BMJ Open. 2015 Dec 23;5(12):e009993. doi: https//doi.org/10.1136/bmjopen-2015-009993
Shojania KG, Grimshaw JM. Evidence-based quality improvement: the state of the science. Health Aff. 2005;24(1):138-150. doi: https//doi.org/10.1377/hlthaff.24.1.138
Dixon-Woods M, Martin GP. Does quality improvement improve quality? Future Hosp J. 2016;3(3):191-194. doi: https//doi.org/10.7861/futurehosp.3-3-191
World Health Organisation. Quality and accreditation in health care services: a global review. Geneva: WHO; 2003. Available at: https://iris.who.int/handle/10665/68410
Bodenheimer T. Coordinating care—a perilous journey through the health care system. N Engl J Med. 2008;358(10):1064-1071. doi: https//doi.org/10.1056/NEJMhpr0706165
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Kazi Ali Aftab, Md. Abul Kalam Azad, Khaled Mahbub Murshed, Abdullah Al Faisal, Md. Hashibul Hasan Shawon, Mohd. Mujtaba Akib Bhuiyan
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
