Referral for 'prostatism': developing a 'performance indicator' for the threshold between primary and secondary care?

Objective. We aimed to define a performance indicator at the gateway betwee n primary and secondary care. Method. We carried out an analysis of referral letters sent to an urologica l department within the catchment area of a teaching hospital in Cardiff, W ales. The subjects were 221 sequential referral letters from 221 GPs. The m ain outcome measures were the information content of referral letters analy sed. Letters were stratified into referral threshold groups by the presence of history, examination, routine investigations and specialized investigat ions. Results. Three distinct categories of referral practice were identified: re ferrals which contained history alone; those providing history examination and a selection of routine investigations; a nd those providing history, ex amination data and the results of routine and specialized investigations. T he study demonstrated that more than a third of GPs do not report the resul ts of digital rectal examination in their referrals and only 4% record urin ary flow rates and post-micturition residual urine volume. Conclusions. The majority (60%) of generalist referrals to an urology depar tment for prostatism provide enough information for specialists to be able to prioritize appointments, but more than a third (36%) of the referrals co ntain inadequate information. The method has the potential of being develop ed into a gateway performance indicator in clinical practice.