Journal Article

7803 Audit on assessment of clinic letters in the department of paediatrics of a district general hospital using the sheffield assessment indicator for letter (SAIL)

Muhammad, Waqas Anwar, Sandra Ayuk Tatah

2025

Overview

Why did you do this work?My motivation was centered on the crucial role of clinic letters in ensuring effective communication between healthcare professionals. Clear and comprehensive clinic letters are essential for maintaining continuity of care and minimizing the risk of miscommunication. By evaluating the quality and completeness of these letters in the Department of Paediatrics at a District General Hospital in Derby and using the Sheffield Assessment Indicator for Letters (SAIL) as a benchmark,1 we aimed to identify and address gaps in documentation practices.What did you do?From August 1 to 30, 2023, a retrospective analysis was conducted on 30 randomly selected clinic letters from the hospital system, with 15 written by consultants and 15 by middle-grade doctors. The SAIL standard was used to evaluate the letters against 20 specific criteria across 7 domains. Each letter received a score out of 20 based on the criteria met, and results were analyzed using Excel. In March 2024, an intervention was implemented to improve the quality of letters. This included creating and displaying posters with guidelines for effective letter writing, strategically placed near every computer used by middle-grade doctors and consultants. Training sessions were conducted for both, focused on best practices in clinical documentation. Following this intervention, second cycle was conducted from April 1 to May 3, 2024, focusing on the domains identified for improvement in the initial audit.What did you find?In the first audit cycle, only 1 of 15 (4%) letters written by consultants required improvement in overall assessment. In contrast, letters from middle-grade doctors showed more significant issues: 3 (20%) needed clarity enhancements, 2 (12%) had management issues and 2 (12%) required improvement in overall assessment. The second audit cycle targeted the identified areas for improvement: overall assessment, management, and clarity. From the second audit cycle, it appeared that the intervention yielded positive results, with consultants showing improvements across all domains. For middle-grade doctors, the second audit cycle showed notable progress in the areas of clarity and overall assessment. Only 1 (6%) of letters required improvement in overall assessment, and 2 (12%) had room for improvement in clarity. However, the management domain still presented a challenge, with 3 (20%) of letters needing improvement in this area.Abstract 7803 Figure 1What does it mean?This audit highlights the effectiveness of simple interventions, such as posters and training sessions, in enhancing clinical communication. It demonstrates that low-cost, straightforward strategies can lead to measurable improvements when properly implemented. However, the limited sample size may restrict the generalizability of the findings. Despite this, the audit successfully identifies areas needing continued focus, particularly management documentation for middle-grade doctors. The results can guide future training initiatives and serve as a model for similar improvements in clinical documentation.ReferenceCrossley JGM, Howe A, Newble D, Jolly B, Davies HA. Sheffield assessment instrument for letters (SAIL): performance assessment using outpatient letters. 2002.

• Publisher: BMJ Publishing Group LTD
• Subject: Audit cycles / Audits / Consultants / Documentation / Intervention / Letters / Medical personnel / Pediatrics / Performance assessment / Performance Based Assessment / Risk reduction / Training