The impact of referral letters on patient outcomes: A randomised control trial with video vignettes in Australian general practice.

This study aims to assess the effectiveness of a computerised referral system, the Referral Writer (RW), to improve the quality of GP referral letters and the ability of specialists to prioritise patient appointments and make a diagnosis. Phase 1: 10 Actor-patient consultations based on a pre-determined script will be video recorded and posted onto a secure password protected website. 'Patients" will present with symptoms of one of six cancers. The 88 Participants (GPs) will asked to view the 10 video consultations, decide whether to refer the ‘patient’ and produce referral letters to specialists. This is envisaged to take a period of one month. Phase 2: Stratified randomisation of the 88 Participants (GPs) will occur and they will be split them into two groups of 44. These groups will be asked to view, over one month, 14 new different video consultations of actor patients presenting with symptoms of one of the six cancers. One group of GP participants, will decide whether to refer the ‘patient’ and produce referral letters to specialists using their standard system of generating letters. The second group of GP participants decide whether to refer the ‘patient’ and produce referral letters to specialists using the RW software. The ability of specialists to triage patients using referral letters produced by standard systems will be compared with triage from referral letters written using the RW software. It is envisaged that phase 2 will take one month. This randomised control trial hopes to provide evidence needed to support the integration of RW into existing clinical systems to enhance the referral process and improve outcomes for patients.