Referral to medical outpatients department at teaching hospitals in Birmingham and Amsterdam.

Hull, F. M.; Westerman, R. F.

doi:10.1136/bmj.293.6542.311

Cited by 27 publications

(17 citation statements)

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“…Previous literature has addressed the importance of good communication between primary care practitioners (PCPs) and subspecialists [3][4][5][6][7][8] , and has highlighted basic principles of PCP-subspecialist relationships [9][10][11][12][13] . However, referral communication is susceptible to breakdowns 3,[14][15][16] .…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

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confidence: 99%

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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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confidence: 99%

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

et al. 2010

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“…3,5 Referrals in the outpatient setting are healthcare processes that are susceptible to breakdowns. [6][7][8][9][10][11] Breakdowns in the referral process can result in poor continuity of care, slow the diagnostic process, 6 cause delays to and repetition of diagnostic tests, 7 contribute to polypharmacy, 6 increase litigation risk, cause patient and provider dissatisfaction and promote loss of confidence in providers. Referral breakdowns threaten the quality of care.…”

Section: Introductionmentioning

confidence: 99%

“…Referral breakdowns threaten the quality of care. [8][9][10][11] Efforts to prevent breakdowns, and to improve and control the referral process across different settings have been reported; these include those using incentive schemes 2,12 and those relying on the use of information technologies to support effective referral communication. 13 Incomplete medical work-ups may result in deferring a decision by the specialist to approve the referral, until an appropriate work-up is completed.…”

Section: Introductionmentioning

confidence: 99%

When your words count: a discriminative model to predict approval of referrals

Esquivel¹,

Dunn²,

McLane³

et al. 2009

Journal of Innovation in Health Informatics

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Objective To develop and test a statistical model which correctly predicts the approval of outpatient referrals when reviewed by a specialty service based on nine discriminating variables. Design Retrospective cross-sectional study. Setting Large public county hospital system in a southern US city. Participants Written documents and associated data from 500 random adult referrals made by primary care providers to various specialty services during the course of one month. Main outcome measures The resulting correct prediction rates obtained by the model. Results The model correctly predicted 78.6% of approved referrals using all nine discriminating variables, 75.3% of approved referrals using all variables in a stepwise manner and 74.7% of approved referrals using only the referral total word count as a single discriminating variable. Conclusions Three iterations of the model correctly predicted at least 75% of the approved referrals in the validation set. A correct prediction of whether or not a referral will be approved can be made in three out of four cases.

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“…Studies elsewhere showed that the number of referrals from primary health care centers to hospitals range from 1 to 28% [4]. Several factors associated with referral rates include: characteristics of the doctors and patients [5], distance from the specialists [6], different case mix [7], list size [8], availability of specialists in the region [9], and differences in health care systems [10].…”

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A Preliminary Report on the Effect of Referral System in Four Areas of the Kingdom of Saudi Arabia

1991

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The effect of implementation of the referral system in health care was studied in four administrative regions of the Kingdom of Saudi Arabia. The study covered the six-month period before and after the implementation of the system. These regions represented the northern, southern, eastern, and central parts of the country. The western region was not included because it was late to implement the system. The study concentrated on the changes that took place in the workload and types of patient problems in hospitals and primary health care centers. The study covered Majma, Dammam Central, Hail General, and Abu Arish hospitals and the 107 health centers attached to them. The size of the hospitals at the time of implementing the referral system was considered during the design of the study. The referral rate was found to range from 3.2 to 4.2%. The number of patients attending the hospital outpatient departments decreased from 43.7% to 65%, but the number of patients attending the accidents/emergency departments increased from 1 to 129.7%. The consultations at the health centers increased from 2.5 to 35.2%. More severe conditions were managed at hospital outpatient departments, while less severe cases were screened and managed at the health care center level. The average duration of stay in all the hospitals remained approximately the same, except for Abu Arish Hospital where it declined by 50%. The bed occupancy rates showed a slight decrease in Dammam and Majma and increase in Hail and Abu Arish. The study suggested certain steps that are necessary to sustain improvement in the referral system. Arabia. 1991; 11(6): 663-668 In 1404H (1984, the Ministry of Health in the Kingdom of Saudi Arabia named primary health care as one of the most important strategies of the fourth five-year plan (1985)(1986)(1987)(1988)(1989)(1990) [1]. This approach has been described as the most outstanding contribution to the overall improvement in the health care delivery services in the last fifteen years. The success story of the adoption of the primary health care approach in the Kingdom within a relatively short time can be attributed to the practical and socially acceptable nature of the scheme [2,3]. However, the approach also requires complete coordination between the three levels of primary, secondary, and tertiary care through a structured referral system, aimed at offering the best possible and most cost-effective services to all the citizens. Studies elsewhere showed that the number of referrals from primary health care centers to hospitals range from 1 to 28%

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Referral to medical outpatients department at teaching hospitals in Birmingham and Amsterdam.

Cited by 27 publications

References 0 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

When your words count: a discriminative model to predict approval of referrals

A Preliminary Report on the Effect of Referral System in Four Areas of the Kingdom of Saudi Arabia

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