Referral letters to pediatric rheumatology: referral content and impact on triage - an observational study

BACKGROUND Delays in access to care in rheumatology are well documented. Many factors contribute to these delays and studies in adult populations indicate that incomplete referral letters may play a role. This study aims to describe the content of referral letters to pediatric rheumatology and to investigate the impact of incomplete letters on time to triage and accessing care. FINDINGS Methods: We evaluated referrals to a tertiary care pediatric rheumatology centre for 8 components of comprehensive referral letters. In addition, we compared time-to-triage and percentage of patients receiving rheumatic diagnoses between letters with sufficient content for immediate triage versus incomplete letters requiring further information. Logistic regression models identified factors associated with delayed triage. Results: Further information was requested for 67/447 (15%) referrals, resulting in median delay in time-to-triage of 1.0 week. Delayed triage was associated with 4 factors: lack of musculoskeletal physical examination, referral from family physicians versus other specialty, missing information regarding management, and lack of rheumatic diagnosis of concern. Rheumatic diagnoses resulted from 42% of all referrals overall, specifically from 170/384 (44%) of immediately triaged referrals and 19/63 (30%) of referrals requiring further information. Rheumatic diagnoses resulted less commonly from family doctors’ referrals. CONCLUSIONS Missing important details in referrals to pediatric rheumatology contribute to delayed assessment. These findings can inform initiatives to educate physicians around relevant content of referral letters to facilitate timely access to care.