Improving the quality of outpatient clinic letters using the Sheffield Assessment Instrument for Letters (SAIL)

Med Educ. 2004 Aug;38(8):852-8. doi: 10.1111/j.1365-2929.2004.01898.x.


Aim: To improve the quality of outpatient letters used as communication between hospital and primary care doctors.

Methods: On 2 separate occasions, 15 unselected outpatient letters written by each of 7 hospital practitioners were rated by another hospital doctor and a general practitioner (GP) using the Sheffield Assessment Instrument for Letters (SAIL). Individualised feedback was provided to participants following the rating of the first set of letters. The audit cycle was completed 3 months later without forewarning by repeat assessment by the same hospital and GP assessors using the SAIL tool to see if there was any improvement in correspondence.

Setting: Single centre: general paediatric outpatient department in a large district general hospital.

Results: All 7 doctors available for reassessment completed the audit loop, each providing 15 outpatient letters per assessment. The mean of the quality scores, derived for each letter from the summation of a 20-point checklist and a global score, improved from 23.3 (95% CI 22.1-24.4) to 26.6 (95% CI 25.8-27.4) (P = 0.001).

Conclusions: The SAIL provides a feasible and reliable method of assessing the quality and content of outpatient clinic letters. This study demonstrates that it can also provide feedback with a powerful educational impact. This approach holds real potential for appraisal and revalidation, providing an effective means for the quality improvement required by clinical governance.

MeSH terms

  • Communication
  • Correspondence as Topic*
  • Family Practice / organization & administration
  • Humans
  • Medical Records / standards*
  • Medical Staff, Hospital / organization & administration
  • Quality Control
  • Referral and Consultation / standards*