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Lalloo et al. [1] are to be commended for undertaking further research on methods of auditing the process and outputs of occupational physicians' reports, which usually take the form of correspondence with referring managers. To supplement their literature search, readers should be aware that your journal has published research regarding this issue in the past and occupational physicians' reports were audited against both an audit standard and the ori­ ginal referring managers' letters [2]. Moreover, the tool first validated by this earlier published research together with allied work has been adapted and made available for more widespread access and use as a Correspondence Assessment/Audit Tool for Occupational Health [3]. Furthermore, it is important to be aware that the Sheffield Assessment Instrument for Letters (SAIL) tool used by the Faculty of Occupational Medicine for trainee assessments and thence by Lalloo et al., was never designed for the purposes of auditing specifically occupational physicians' correspondence. Indeed, it was validated as a pedagogic tool to improve outpatient letters by paediatric registrars [4]. Thus, while SAIL may have face or construct validity at a generic level for physicians' outpatient correspondence, usually when writing to other doctors, it lacks content validity at the level of specifically assessing occupational health reports. Occupational phy­ sicians' reports address key questions such as patients' sickness absence, fitness, performance and safety at work as well as occupational rehabilitation, and these form the basis of previously validated audit items [2]. However, none of these specific items are intrinsic to SAIL, nor indeed to the Faculty of Occupational Medicine's adap­ tation [5], both of which are therefore limited in their capacity to audit the explicit and essential detail of most occupational physicians' letters or reports. Finally, the authors are right in acknowledging 'the question of internal consistency between reviewers' as a potential weakness in the interpretation of SAIL and in their audit. In contrast, the reliability of the previously published audit tool [2] has been studied [6], although more research to continuously improve audit tools in occupational health is warranted and welcome. (Sheffield Assessment Instrument for Letters (OH)). First re-ferral from a manager. Reply We thank Professor Agius for his comments [1]. Our key objective was to assess the outcomes of the peer review process and the proportion of occupational health (OH) reports that required modifications before release and we felt it was important to concentrate on more recent developments in this …

Audit or assessment tools for occupational health letters or reports