{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T10:34:41Z","timestamp":1761561281552,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Qual Health Care"],"published-print":{"date-parts":[[1993,6]]},"abstract":"<jats:p>The quality of anticoagulant treatment of ambulatory patients is affected by the content of referral letters and administrative processes. To assess these influences a method was developed to audit against the hospital standard the referral of patients to one hospital anticoagulant clinic in a prospective study of all (80) new patients referred to the clinic over eight months. Administrative information was provided by the clinic coordinator, and the referral letters were audited by the researchers. Referral letters were not received by the clinic for 10% (8\/80) of patients. Among the 72 referral letters received, indication for anticoagulation and anticipated duration of treatment were specified in most (99%, 71 and 81%, 58 respectively), but only 3% (two) to 46% (33) reported other important clinical information (objective investigations, date of starting anticoagulation, current anticoagulant dose, date and result of latest international normalised ratio, whether it should be the anticoagulant clinic that was eventually to stop anticoagulation, patients' other medical problems and concurrent treatment. Twenty two per cent (16\/80) of new attenders were unexpected at the anticoagulant clinic. Most patients' case notes were obtained for the appointment (61%, 47\/77 beforehand and 30% 23\/77 on the day), but case notes were not obtained for 9% (7\/77). The authors conclude that health professionals should better appreciate the administrative and organisational influences that affect team work and quality of care. Compliance with a well documented protocol remained below the acceptable standard. The quality of the referral process may be improved by using a more comprehensive and helpful referral form, which has been drawn up, and by educating referring doctors. Measures to increase the efficiency of the administrative process include telephoning the clinic coordinator directly, direct referrals through a computerised referral system, and telephone reminders by haematology office staff to ward staff to ensure availability of the hospital notes. The effect of these changes will be assessed in a repeat audit.<\/jats:p>","DOI":"10.1136\/qshc.2.2.96","type":"journal-article","created":{"date-parts":[[2008,9,29]],"date-time":"2008-09-29T13:52:26Z","timestamp":1222696346000},"page":"96-99","source":"Crossref","is-referenced-by-count":5,"title":["Referral of patients to an anticoagulant clinic: implications for better management."],"prefix":"10.1136","volume":"2","author":[{"given":"G B","family":"Tan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F C","family":"Taylor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Gabbay","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1993,6,1]]},"reference":[{"key":"ref_1","first-page":"197","article-title":"Anticoagulation clinics and the monitoring of anticoagulant therapy. Int J7 Cardiol","volume":"18","author":"Charney, R.; Leddomado, L.; Rose, D.N.; Fuster, V.","year":"1988","unstructured":"Charney R, Leddomado L, Rose DN, Fuster V. Anticoagulation clinics and the monitoring of anticoagulant therapy. Int J7 Cardiol 1988;18: 197-206."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1136\/bmj.299.6701.722","article-title":"Referrals from general practice to hospital outpatient departments: a strategy for improvement","volume":"299","author":"Emmanuel, J.; Walter, N.","year":"1989","unstructured":"Emmanuel J, Walter N. Referrals from general practice to hospital outpatient departments: a strategy for improvement. BMJ 1989;299:722-4.","journal-title":"BMJ"},{"key":"ref_3","first-page":"445","article-title":"A study of communication between general practitioners and specialists","volume":"40","author":"Westerman, R.F.; Hull, F.M.; Bezemer, P.D.; Gort, G.","year":"1990","unstructured":"Westerman RF, Hull FM, Bezemer PD, Gort G. A study of communication between general practitioners and specialists. Br J Gen Prac 1990;40:445-9.","journal-title":"Br J Gen Prac"},{"key":"ref_4","first-page":"177","article-title":"British Society for Haematology, British Committee for Standards in Haematology, Haemostasis and Thrombosis Task Force. Guidelines on oral anticoagulation: second edition","volume":"432","year":"1990","unstructured":"British Society for Haematology, British Committee for Standards in Haematology, Haemostasis and Thrombosis Task Force. Guidelines on oral anticoagulation: second edition. J Clin Pathol 1990;432:177-83.","journal-title":"J Clin Pathol"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1136\/bmj.301.6751.526","article-title":"What did medical audit achieve? Lessons from the preliminary evaluation of a year's medical audit","volume":"301","author":"Gabbay, J.; McNicol, M.; Spiby, J.; Davies, S.C.; Layton, A.J.","year":"1990","unstructured":"Gabbay J, McNicol M, Spiby J, Davies SC, Layton AJ. What did medical audit achieve? Lessons from the preliminary evaluation of a year's medical audit. BMJ 1990;301:526-9.","journal-title":"BMJ"},{"key":"ref_6","article-title":"Statistical methods for rates and proportions","author":"Fleiss, J.","year":"1973","unstructured":"Fleiss J. Statistical methods for rates and proportions. London: Wiley, 1973."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1093\/aje\/126.2.161","volume":"126","author":"Maclure, M.; Misinterpretation, Willett W.C.; misuse of Kappa","year":"1987","unstructured":"Maclure M, Willett WC. Misinterpretation and misuse of Kappa. 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