Quality of psychiatric referral letters in a Nigerian tertiary hospital: a one-year clinical audit

Background: Effective referral communication is essential for safe and efficient psychiatric care. Inadequate referral information may delay diagnosis, compromise patient safety, and disrupt appropriate prioritization of care. Aim: This study audited the completeness and overall quality of referral letters received at the in-patient unit of a teaching hospital in North-Central Nigeria. Methods: A retrospective cross-sectional audit of 81 referral letters received between August 2024 and July 2025 was conducted. Referral letters were assessed using a ten-item structured checklist, informed by American Psychiatric Association (APA) and Royal College of Psychiatrists standards. Each item was scored as present or absent, generating a total score ranging from 0 to 10. Overall quality was categorized as poor (0–3), moderate (4–6), or good quality (7–10). Data were analyzed descriptively. Results: Only 3.7% of referral letters met criteria for good quality. Total checklist scores ranged from 1-7 with mean score of 4.04 (SD=1.36). Although patient biodata (98.8%) and presenting complaints (96.3%0 were frequently documented, critical psychiatric information was largely absent. Mental state examination was recorded in only one letter (1.2%), while Past psychiatric history (18.5%) and psychosocial history (13.6%) were poorly documented. Most referrals originated from the Adult Emergency Medical Ward. Conclusion: Psychiatric referral letters in this setting frequently lacked essential clinical information required for effective triage and management. Hospital-wide adoption of standardized referral templates, targeted clinician training, and routine audits may improve referral quality and enhance the efficiency of psychiatric care delivery.