The quality of referral letters in two health centers in Riyadh.

A review of 100 referral letters and reports randomly selected from two health centers in Riyadh identified that the main reason for referral was general therapeutic advice (43.2%), general diagnostic evaluation (24.8%), and routine specialist examination (11.7%). Of the total referrals, 82.1% were seen within a week in the specialist clinic. Important clinical information was lacking from both referral letters and feedback reports. For instance, past medical history, current therapy, final diagnosis, and decision on future care were omitted in 75%, 86%, 24.2%, and 56% of the letters and reports, respectively. Moreover, consultants' recommendations were specific and clear in only 56.9%. A quantitative evaluation of the quality of letters revealed that 26% of the referral and 47% of the feedback reports were poor. The referral process needs tremendous improvement if the quality of patient care is to be guaranteed.