Qualitative Assessment of Answer Letters of Patients with Chronic Fatigue and a Psychiatric Disorder

Monday, 28 July 2014: 7:00 AM

P. Vermeir, RN, MPM, MBA, MPA1
S. Degroote, MS2
D. Vogelaers, MD3
E. Tobback, PhD3
L. Delesie, RN3
D. Vandijck, PhD3
(1)Department of General Internal Medicine, Infectious Diseases and Psychosomatics, Ghent University Hospital, Ghent, Belgium
(2)Ghent University, Ghent, Belgium
(3)Ghent University Hospital, Ghent, Belgium


Care delivery is a complex process, involving many different actors (physicians, nurses,…). Appropriate communication between those actors is of key to guarantee qualitative and thus safe care. Referral letters are one of the most important means of communication between care providers. The aim of this study was to perform a qualitative assessment of the content of referral letters (second to first level providers) of patients with chronic fatigue and a psychiatric disorder.


The study was conducted by the head nurse of the department of General Internal Medicine of Ghent University Hospital. Based on a comprehensive search of the literature, a checklist of respectively 24 quality indicators was developed assessing the content and way of interdisciplinary communication between -second and first level providers. Indicators were considered as dichotomous variables (present/absent). All referral letters (June 2010–February 2011) of 126 patients with chronic fatigue and a psychiatric disorder were considered.


The study cohort consisted of 108 (85.7%) females, mean age was 39.3±11.1 years. Of the 24-item

checklist, on average 18.7±2.1 of the indicators were present. Telephone number of the referring

physician was never included 0% (0/126), reason of initial referral was not mentioned in

96%(121/126) of the letters. Information about allergic status was missing in 42.9%(54/126), current

medication in 17.5%(22/126), surgical and medical history in 34.1%(43/126) and 9.5%(12/126) of the

cases. Psychosocial information was not included in 22.2%(28/126) and 63.5%(80/126) of the letters

did not mention the dates investigations were performed. Average time-delay between consultation

with secondary care provider and sending the referral letter was 44.2±47.7 days .


In this patient sample, referral letters from secondary to primary care level providers often lack

crucial information that is of key to ensure high quality of patient care. Targeted interventions aimed

at improving communication inefficiencies between multidisciplinary care levels are warranted.