Does Referral Letter Quality Influence Specialist Wait Times? a Cross-Sectional Study in South-West Nigeria

Background Timely access is increasingly being recognized as a marker for quality in healthcare. Wait time from referral to first appointment at specialist clinics is one of the several delays encountered by patients in the care continuum, constituting a significant healthcare barrier. The referral letter, being the main communication channel between referring healthcare providers and specialists, is a crucial tool in the triage process. The interplay between referral quality, and specialist appointment wait times therefore holds significant implications for both patient outcomes and healthcare system efficiency. Aim This study aimed to determine the relationship between the quality of referrals and the wait times of patients referred to the Specialist clinics of a tertiary centre in South-West Nigeria. Methods This was a cross-sectional study of 310 patients (aged 18 years and above) requiring referrals from the Family Medicine General Outpatient (GOP) Clinic to the Medical Outpatient (MOP), Surgical Outpatient (SOP) and Psychiatry clinics of a tertiary centre in South-West Nigeria. Referral letter quality was assessed by two independent assessors with the Consultation and Referral Request Letter Assessment tool. The participants were followed up by phone calls to obtain their specialist appointment dates. Data was analysed using the Statistical Package for Social Sciences (SPSS) Version 28 and the level of significance set at 5%. Results More than half (52.3%) of the respondents’ first appointment wait times were less than 1 month, about 37.1% within 1 and 3 months and about a tenth had over 3 months. The referral letters were helpful in the triage process to varying degrees with less than 5% of the referral letters assessed as extremely helpful and informative and 1% being totally unhelpful. There was, however, no statistically significant relationship between the quality of referrals and specialist wait times (r = -0.024, p-value 0.674 > 0.05). Conclusion While referral quality remains important for clinical communication, our findings indicate that it was not a significant driver of specialist wait times in this study. This suggests that future strategies to reduce delays should extend beyond referral content to address broader systemic and administrative factors influencing patient access