Setting

This audit was within intellectual disability psychiatry but may be relevant to out-patient follow-up clinics in other areas in psychiatry.

Background

Out-patient letters between secondary and primary care are an important form of communication. With restructuring of mental health services and closure of large psychiatric hospitals, an increasing number of patients with intellectual disability and mental health problems have been resettled in the community and are under the care of general practitioners (GPs). This audit examined the quality of letters that were sent out to GPs after their patients were assessed in follow-up clinics.

Standards

A literature review was performed (sources are listed below) and, following discussion with colleagues, standards were defined. The following were to be included in all letters:

ᐅ patient's demographics

ᐅ date of clinic

ᐅ patient's diagnosis

ᐅ update on symptoms/problems

ᐅ current mental state

ᐅ current medication and dosage

ᐅ opinion/summary

ᐅ follow-up arrangements. Other points which could be considered are:

ᐅ copies sent to multidisciplinary team or patient

ᐅ letters are sent within a certain time after the appointment

ᐅ comment on quality of life.

Method

Data collection

Out-patient letters to GPs were examined against the defined standards. Medical secretaries had a list of all patients who attended out-patient clinics for follow-up and were able to provide the letters. Alternatively, out-patient follow-up letters were found in patients’ clinical notes.

Data analysis

The percentage of patients for whom the standards were met was calculated.

Resources required

People

One person can undertake this audit.

Time

The duration of data collection will depend on the time required to access the letters and the length of the out-patient letters. Data collection from 50 letters (at an average length of half an A4 page) took about 2 hours.

Results

The documentation of demographics, date of clinic, update on symptoms/ problems and follow-up arrangements was very good. Within the letters collected, 71% reported the patient's medication, including dosage, 57% their mental state, 16% a diagnosis and 27% an opinion/summary.

After implementing the steps below, documentation had improved dramatically at the time of a re-audit.