Impact of inter-physician communication on the effectiveness of medical consultations

Lee, Thomas; Pappius, Elizabeth M.; Goldman, Lee

doi:10.1016/0002-9343(83)91126-9

Cited by 137 publications

(80 citation statements)

References 11 publications

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“…In discontinuing referrals subspecialists stated justifications, such as lack of prerequisite workup, which suggest possible disagreement on criteria for referral to their services. This is consistent with a previous study of communication breakdowns in which subspecialists and PCPs did not consistently agree about the reasons for referrals 24 . In a few cases, subspecialists did not believe sufficient information was provided in the referral to make an informed decision.…”

Section: Discussionsupporting

confidence: 92%

Follow-up Actions on Electronic Referral Communication in a Multispecialty Outpatient Setting

et al. 2010

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OBJECTIVES: Electronic health records (EHR) enable transmission and tracking of referrals between primarycare practitioners (PCPs) and subspecialists. We used an EHR to examine follow-up actions on electronic referral communication in a large multispecialty VA facility. METHODS: We retrieved outpatient referrals to five subspecialties between October 2006 and December 2007, and queried the EHR to determine their status: completed, discontinued (returned to PCP), or unresolved (no action taken by subspecialist). All unresolved referrals, and random samples of discontinued and completed referrals were reviewed to determine whether subspecialists took follow-up actions (i.e., schedule appointments anytime in the future) within 30 days of referral-receipt. For referrals without timely follow-up, we determined whether inaction was supported by any predetermined justifiable reasons or associated with certain referral characteristics. We also reviewed if PCPs took the required action on returned information. RESULTS: Of 61,931 referrals, 22,535 were discontinued (36.4%), and 474 were unresolved (0.8%). We selected 412 discontinued referrals randomly for review. Of these, 52% lacked follow-up actions within 30 days. Appropriate justifications for inaction were documented in 69.8% (150/215) of those without action and included lack of prerequisite testing by the PCP and subspecialist opinion that no intervention was required despite referral. We estimated that at 30 days, 6.3% of all referrals were associated with an unexplained lack of follow-up actions by subspecialists. Conversely, 7.4% of discontinued referrals returned to PCPs were associated with an unexplained lack of follow-up. CONCLUSIONS: Although the EHR facilitates transmission of valuable information at the PCP-subspecialist interface, unexplained communication breakdowns in the referral process persist in a subset of cases.

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Section: Discussionsupporting

confidence: 92%

Follow-up Actions on Electronic Referral Communication in a Multispecialty Outpatient Setting

et al. 2010

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“…In addition, other studies than our own have found questionable impact on patient management by medical and cardiology consults 4 as well as lack of specificity as to the reasons for requesting a consult 4,5 and frequently poor communication between consultants and other physicians. 1,5 It seems unlikely, therefore, that our results could be unique to any particular institution.…”

Section: Discussionmentioning

confidence: 89%

“…In 1983, a study by Lee 1 documented that in 14% of cases, requesting physicians and medical consultants actually disagreed on the reasons for the consult. Rudd,5 in a study on preoperative medical consultations for diabetic patients, found that no specific question was asked by the requesting physician in 24% of cases, and in 12%, consulting physicians ignored the questions that were asked.…”

Section: Discussionmentioning

confidence: 99%

Preoperative medical consultations: impact on perioperative management and surgical outcome

Katz

Cimino

Vitkun

2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : This study was designed to assess the effect of preoperative medical consults on both perioperative management and surgical outcome.M Me et th ho od ds s: : The charts of 387 consecutive patients over the age of 50 undergoing non-cardiac, elective surgery during a six-week period were retrospectively examined. Patient factors including age, ASA status, gender, type of surgery, outcome (death, unexpected intensive care unit admission or uncomplicated discharge), presence of medical consult, and, in those cases where a medical consult was present, stated reason for the consult, the ordering physician, and recommendations of the consultant, were recorded. R Re es su ul lt ts s: : 138 patients receiving medical consults (35.7%) were identified (a total of 146 consults). The most common stated purpose of the consults examined was "preoperative evaluation." In only five consults (3.4%) did the consultant identify a new finding. Sixty-two consults (42.5%) contained no recommendations. There was no statistically significant difference in outcome between those patients who received a medical consult and those who did not.C Co on nc cl lu us si io on n: : A review of 146 medical consults suggests that the majority of such consults give little advice that truly impacts either perioperative management or outcome of surgery. NESTHESIOLOGISTS and surgeons frequently request preoperative consultation from internists and family practitioners for patients with pre-existing or suspected disease. There can be considerable confusion, however, amongst physicians regarding both the reasons for which a consult was requested 1 and the ultimate purposes that the consult serves. Objectif : Évaluer l'effet des consultations médicales préopératoires2 Such confusion often results in consultants' recommendations being ignored.3 Kleinmann found that very few anesthesiologists or surgeons specify what is being requested when asking for a cardiology consult.4 Lee 1 documented that in 14% of cases, requesting physicians and medical consultants actually disagreed on the reasons for the consult. Rudd, 5 in a study on preoperative

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“…In the current study, consultants failed to make their recommendations clear in more than half of the reports. Consultants' recommendations are more likely to be followed if they are limited in number, clear, specific, and focus on issues central to current patient care [5][6][7]· The quality of referral letters and reports was further evaluated by scoring each component. The overall frequency of poor referral letters was 26% while the overall frequency of poor reports was 47%, though this was less so for the DHC than the RHC.…”

Section: Discussionmentioning

confidence: 99%

The Quality of Referral Letters in Two Health Centers in Riyadh

Jarallah

1991

Ann Saudi Med

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A review of 100 referral letters and reports randomly selected from two health centers in Riyadh identified that the main reason for referral was general therapeutic advice (43.2%), general diagnostic evaluation (24.8%), and routine specialist examination (11.7%). Of the total referrals, 82.1% were seen within a week in the specialist clinic. Important clinical information was lacking from both referral letters and feedback reports. For instance, past medical history, current therapy, final diagnosis, and decision on future care were omitted in 75%, 86%, 24.2%, and 56% of the letters and reports, respectively. Moreover, consultants' recommendations were specific and clear in only 56.9%. A quantitative evaluation of the quality of letters revealed that 26% of the referral letters and 47% of the feedback reports were poor. The referral process needs tremendous improvement if the quality of patient care is to be guaranteed. Riyadh. 1991; 11(6): 658-662 Referral is the process of one physician requesting another physician to examine a patient to obtain advice or management [1]. It is an important aspect of patient care, but if the quality of patient care is to be guaranteed, it is essential that referral be accomplished successfully. Important steps in this process include: communication of the need and purpose of the referral to the consultant, communication of the consultant's findings and recommendations to the referring physician, and mutual decision on continuing care [2,3]. Failure in communication can occur at any of these steps. JS Jarallah, The Quality of Referral Letters in Two Health Centers inThe referring physician may fail to phrase a clear-cut question [4], inadequate information may be provided [5], the consultant may not address the referring physician's question [4,6], he may fail to communicate his findings to the referring physician [1,3], or he may make recommendations that are not clear or may even be inappropriate [6,7]. In 1984, the Ministry of Health in the Kingdom of Saudi Arabia adopted primary health care as an important objective of the fourth five-year plan (1985)(1986)(1987)(1988)(1989)(1990) [8]. Successful primary health care services require complete coordination between the primary, secondary (general hospitals), and tertiary (specialist hospitals or specialist units in general hospitals) levels of care through a structured referral system, aimed at offering the best possible and most cost-effective services to all citizens. In Saudi Arabia, the obligatory referral system was implemented in all regions to improve the organization of services and hence provide better patient care.There are predesigned standard forms for referrals which obtain important relevant clinical and social information, along with brief notes on the investigations done and the resulting findings and recommendations [9]. No attempt has been made to evaluate the referral system even though evaluation is an integral part of the managerial process. However, improvement in the quality of patient care depends o...

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Impact of inter-physician communication on the effectiveness of medical consultations

Cited by 137 publications

References 11 publications

Follow-up Actions on Electronic Referral Communication in a Multispecialty Outpatient Setting

Follow-up Actions on Electronic Referral Communication in a Multispecialty Outpatient Setting

Preoperative medical consultations: impact on perioperative management and surgical outcome

The Quality of Referral Letters in Two Health Centers in Riyadh

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