Primary care referrals of patients with potentially serious diseases to the emergency department or a quick diagnosis unit: a cross-sectional retrospective study

Bosch, Xavier; Escoda, Ona; Nicolás, David; Coloma, Emmanuel; Fernández, Sara; Coca, António; López‐Soto, Alfonso

doi:10.1186/1471-2296-15-75

Cited by 21 publications

(20 citation statements)

References 27 publications

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“…Bosch et al [ 40 ] published a paper on referrals from GPs to a quick diagnostic unit (QDU) similar to the one described in this paper, but their aim was different from ours. The study showed that 30 % of the patients referred directly to the QDU had cancer compared to the 16 % found in our study.…”

Section: Discussionmentioning

confidence: 93%

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The Danish cancer pathway for patients with serious non-specific symptoms and signs of cancer–a cross-sectional study of patient characteristics and cancer probability

et al. 2015

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BackgroundA Danish cancer pathway has been implemented for patients with serious non-specific symptoms and signs of cancer (NSSC-CPP). The initiative is one of several to improve the long diagnostic interval and the poor survival of Danish cancer patients. However, little is known about the patients investigated under this pathway. We aim to describe the characteristics of patients referred from general practice to the NSSC-CPP and to estimate the cancer probability and distribution in this population.MethodsA cross-sectional study was performed, including all patients referred to the NSSC-CPP at the hospitals in Aarhus or Silkeborg in the Central Denmark Region between March 2012 and March 2013. Data were based on a questionnaire completed by the patient’s general practitioner (GP) combined with nationwide registers. Cancer probability was the percentage of new cancers per investigated patient. Associations between patient characteristics and cancer diagnosis were estimated with prevalence rate ratios (PRRs) from a generalised linear model.ResultsThe mean age of all 1278 included patients was 65.9 years, and 47.5 % were men. In total, 16.2 % of all patients had a cancer diagnosis after six months; the most common types were lung cancer (17.9 %), colorectal cancer (12.6 %), hematopoietic tissue cancer (10.1 %) and pancreatic cancer (9.2 %). All patients in combination had more than 80 different symptoms and 51 different clinical findings at referral. Most symptoms were non-specific and vague; weight loss and fatigue were present in more than half of all cases. The three most common clinical findings were ‘affected general condition’ (35.8 %), ‘GP’s gut feeling’ (22.5 %) and ‘findings from the abdomen’ (13.0 %). A strong association was found between GP-estimated cancer risk at referral and probability of cancer.ConclusionsIn total, 16.2 % of the patients referred through the NSSC-CPP had cancer. They constituted a heterogeneous group with many different symptoms and clinical findings. The GP’s gut feeling was a common reason for referral which proved to be a strong predictor of cancer. The GP’s overall estimation of the patient’s risk of cancer at referral was associated with the probability of finding cancer.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1424-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 93%

“…Data from the UK have shown that 11 % of the patients referred to the ordinary urgent referral pathways were diagnosed with cancer [ 22 ]. Apart from the study by Bosch et al [ 40 ], we are unaware of any published studies examining and quantifying GP referrals to NSSC-CPPs and related outcomes.…”

Section: Discussionmentioning

confidence: 99%

The Danish cancer pathway for patients with serious non-specific symptoms and signs of cancer–a cross-sectional study of patient characteristics and cancer probability

et al. 2015

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“…Lengthy waits in diagnostic workups owe to insufficiencies in outpatient services, with diagnosis in such settings being unfeasible, even when quick investigations for suspected cancer are necessary [ 14 – 16 ]. Because current referral procedures for diagnosis and specialized care in primary healthcare centers (PCCs) are prolonged, especially in public health systems such as the Spanish one, PCC physicians commonly refer patients with suspected serious diseases to the emergency department (ED) with the hope to gain quick access to examinations via hospitalization [ 12 , 13 , 17 , 18 ]. Alternatively, patients are free to pay for diagnostic tests such as a CT scan or MRI using a private provider [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although still little known today, this type of units, run by internists, nurses, and secretarial staff, have been established in Europe, and they have been principally studied in Spain [ 1 , 2 , 4 , 12 – 15 , 17 , 18 , 20 – 24 ]. The advantages over conventional hospitalization are numerous: in addition to ensuring an early diagnosis, QDUs avoid hospital-related morbidity, decrease ED referrals from PCCs and decongestion overcrowded ED, and help decrease unnecessary health costs of traditional hospitalization without lowering the quality of diagnostic practice and patient care [ 2 , 12 , 14 , 17 , 18 , 21 – 24 ]. Yet for QDUs to succeed, the following requirement are expected to be met: 1) clear pre-established referral criteria; 2) patients should be well enough to attend outpatient appointments for visits and diagnostic tests; 3) their first visit has to occur as soon as possible after referral; and 4) they should have preferential access to diagnostic tests [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Perception of quality of care of patients with potentially severe diseases evaluated at a distinct quick diagnostic delivery model: a cross-sectional study

Sanclemente-Ansó

Salazar

Bosch

et al. 2015

BMC Health Serv Res

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BackgroundAlthough hospital-based outpatient quick diagnosis units (QDU) are an increasingly recognized cost-effective alternative to hospitalization for the diagnosis of potentially serious diseases, patient perception of their quality of care has not been evaluated well enough. This cross-sectional study analyzed the perceived quality of care of a QDU of a public third-level university hospital in Barcelona.MethodsOne hundred sixty-two consecutive patients aged ≥ 18 years attending the QDU over a 9-month period were invited to participate. A validated questionnaire distributed by the QDU attending physician and completed at the end of the first and last QDU visit evaluated perceived quality of care using six subscales.ResultsResponse rate was 98 %. Perceived care in all subscales was high. Waiting times were rated as ‘short’/’very short’ or ‘better’/’much better’ than expected by 69–89 % of respondents and physical environment as ‘better’/’much better’ than expected by 94–96 %. As to accessibility, only 3 % reported not finding the Unit easily and 7 % said that frequent travels to hospital for visits and investigations were uncomfortable. Perception of patient–physician encounter was high, with 90–94 % choosing the positive extreme ends of the clinical information and personal interaction subscales items. Mean score of willingness to recommend the Unit using an analogue scale where 0 was ‘never’ and 10 ‘without a doubt’ was 9.5 (0.70). On multivariate linear regression, age >65 years was an independent predictor of clinical information, personal interaction, and recommendation, while age 18–44 years was associated with lower scores in these subscales. No schooling predicted higher clinical information and recommendation scores, while university education had remarkable negative influence on them. Having ≥4 QDU visits was associated with lower time to diagnosis and recommendation scores and malignancy was a negative predictor of time to diagnosis, clinical information, and recommendation.DiscussionIt is worthy of note that the questionnaire evaluated patient perception and opinions of healthcare quality including recommendation rather than simply satisfaction. It has been argued that perception of quality of care is a more valuable approach than satisfaction. In addition to embracing an affective dimension, satisfaction appears more dependent on patient expectations than is perception of quality.ConclusionsWhile appreciating that completing the questionnaire immediately after the visit and its distribution by the QDU physician may have affected the results, scores of perceived quality of care including recommendation were high. There were, however, significant differences in several subscales associated with age, education, number of QDU visits, and diagnosis of malignant vs. benign condition.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1070-2) contains supplementary material, which is available to authorized users.

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“…In settings where there are weak referral structures, due to inappropriate referral practices, hospital level maternal and new-born mortality is often higher (4). Ineffective referral systems result in negative patient experiences, unnecessary high costs and are a burden on health system (9). The appropriateness of the referrals can be de ned by their distinct attributes -referral necessity, referral destination and referral quality (10).…”

Section: Introductionmentioning

confidence: 99%

Prevalence and factors related to inappropriate referrals during intrapartum care – a mixed method study

Desta¹,

Dolamo²

2020

Preprint

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Background: Complications during delivery are responsible for half of all maternal deaths, one-third of stillbirths and a quarter of neonatal deaths. The care necessitates emergency care, and it is a known fact that reductions in maternal mortality and morbidity are not possible without an effective referral system. This study is aimed at measuring the prevalence of inappropriate referrals and identifying factors that contribute to it. Methods: The study employed a sequential explanatory mixed research design. In the first phase, a retrospective cross-sectional quantitative study was done, 718 medical records were reviewed. The second phase involved a qualitative study of 26 key informants being interviewed. Results: Three quarters of cases, (74.23%; n=533), who visited the selected hospitals could have been managed at the health center level. Sixty-five percent of them, (n=436), sought care at the hospital level with no referral from the lower level. Further analysis of the data showed no major difference as to the appropriateness of hospital level care in relation to age of mothers, previous medical and obstetrics history as well as danger signs at admission. On the other hand, number of parities, (chi-square = 9.3; P-value = 0.010), frequency of ANC, (chi-square = 6.7; p-value = 0.037) and the institution where ANC was sought, (chi-square = 12.9; p-value = 0.005) were found to be associated with appropriateness of the case for hospital level care. Further inventory of the referred cases revealed that 33.2% of referred cases were appropriate for hospital level care. In addition, the qualitative study identified three major themes in relation to appropriateness of referrals: capability of identifying appropriate cases for referral, proper initiation of the referral process determining the outcome and functional cross-facility support platforms for better collaboration and coordination between facilities. Conclusion: Referral, which is the coordination between facilities, requires readiness of the facilities at both ends as well as a transportation system. The governance system should also be strengthened to ensure the emergency management system in the country is effective.

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Primary care referrals of patients with potentially serious diseases to the emergency department or a quick diagnosis unit: a cross-sectional retrospective study

Cited by 21 publications

References 27 publications

The Danish cancer pathway for patients with serious non-specific symptoms and signs of cancer–a cross-sectional study of patient characteristics and cancer probability

The Danish cancer pathway for patients with serious non-specific symptoms and signs of cancer–a cross-sectional study of patient characteristics and cancer probability

Perception of quality of care of patients with potentially severe diseases evaluated at a distinct quick diagnostic delivery model: a cross-sectional study

Prevalence and factors related to inappropriate referrals during intrapartum care – a mixed method study

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