Quality of Consultation-liaison Referrals to the Psychiatry Department in a Nigerian Teaching Hospital: A Retrospective Study.

Background: Efficient consultation-liaison referrals to psychiatrists are essential in a multidisciplinary healthcare setting to optimise care, reduce unnecessary costs and bridge the treatment gap in mental health.

Aims: The aim of this study is to analytically assess the quality and to identify deficiencies of consultation-liaison referrals from various medical specialties to psychiatry in a teaching hospital in Nigeria.

Methods: A retrospective review of 263 in-hospital referral letters to the Psychiatry Department from January 2022 to April 2024 at the Nnamdi Azikiwe University Teaching Hospital, Nigeria, was conducted. Referrals addressed to clinical psychologists were excluded. An adapted 'Consultation and Referral Request Letter Assessment Tool' was utilised to assess the quality of referrals, which was then categorised into 'poor', 'fair' and 'good'.

Results: The mean patient age was 40.68 years, with a balanced gender distribution. The study demonstrated that only 4.9% of the letters lacked a referral reason. Timing and urgency indicators were lacking in over 95% of the letters, and ongoing treatment information was absent in 77.2% of referrals. Notably, a quarter (25.1%) of the referral letters were objectively rated as poor in quality. The perceived usefulness of the referrals was significantly associated with the objectively assessed quality of the referrals (P = 0.01).

Conclusion: This audit highlights substantial deficiencies in referral letters to psychiatric services, which could complicate efficient triaging. There is a pressing need for a standardised referral template and education to enhance the quality of medical referrals, thus improving patient outcomes and resource utilisation.