Developing a standard safe patient referral from emergency medicine (EM) staff to hospital inpatient specialties was the objective of the study which identified several problems in existing referrals.

Researchers at Lister Hospital in Stevenage, England, piloted a questionnaire on 30 junior doctors in a two week period and then contacted a further 42 doctors. When asked did they have any difficulties with referrals, 56% said yes, although further questioning revealed problems had been faced by every doctor interviewed.

Some said that specialty doctors appeared to assume EM doctors were 'inferior'.

Conclusions from the audit were that A&E doctors were usually young and relatively inexperienced and there could be problems of personality clashes with the doctor accepting patients, particular specialities that were difficult to refer to, and the EM doctors' knowledge of the subject.

Recommendations were made including that there be formal teaching of referral to new EM doctors (perhaps even in medical school), there should be clear guidelines as to the role of EM, the role of the specialities in accepting patients, and education of the specialties on acceptance of referrals. These recommendations were implemented at the Lister Hospital with positive results and there has been widespread support for the new approach.

Teaching for EM junior medical staff is now focused on this area. The topic of referrals now has more prominence and role playing has been introduced. New doctors are not allowed to refer on their own for the first two weeks in post and are given intense support and supervision.

The authors say: ''Education about how to refer appropriately and how to accept referrals sets clear markers enabling the team working
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Contact: Emma Dickinson
edickinson@bmj.com
44-207-383-6529
BMJ Specialty Journals
20-Apr-2005