How is the updated Ticket of Referral doing?

Abstract

Introduction: The outpatient interface is important for patient care. An updated Ticket of Referral (TOR) was introduced end 2013; our study reviewed its usage in referrals from primary to secondary care, using Medical Consultant (MCC)/Schedule V clinics as an exemplar. Methods: Prospective study of consecutive new case referrals with all personal data anonymised. Completeness of field completion, established quality criteria, and legibility were assessed, and whether written or printed. Results: Of 103 consecutive referrals, 3 exclusions were due to an older version submitted, resulting in n=100. Identity card number, name, address, reasons for referral and referring doctor signature were completed in 100%; with 'date' in 98% and 'referring doctor' name, and 'registration number' in 96%. 88% had a rubber stamp; 79% completed 'age', 76% 'telephone', 47% 'mobile'; date of birth completes in 10 out of 66 possible, (due to differing versions of the TOR). 19% completed 'Next of Kin' - with telephone number (13%) and mobile numbers (18 %). 22% were noted to have investigations and 1% attendance at other clinics. Quality criteria included past history (54%), current treatment (71%) and blood pressure (34%); 100% were written, with 19% containing illegible areas. Conclusion: Data completion was high for patient and doctor details and reasons for referral, whilst fields related to 'Next of Kin' were mainly omitted. Quality criteria were variably completed - notably current treatment was absent in over a quarter - with implications for patient safety. Legibility was an issue in 19%.