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Noncompletion of referrals to outpatient specialty clinics among patients discharged from the emergency department: a prospective cohort study

Published online by Cambridge University Press:  21 May 2015

Steven Marc Friedman ,
Jennifer Vergel de Dios  and
Kate Hanneman
Steven Marc Friedman*
Affiliation:
Department of Family and Community Medicine, University of Toronto, Toronto, Ont. Department of Emergency Medicine, University Health Network, Toronto, Ont.
Jennifer Vergel de Dios
Affiliation:
Department of Family and Community Medicine, University of Toronto, Toronto, Ont.
Kate Hanneman
Affiliation:
Department of Family and Community Medicine, University of Toronto, Toronto, Ont.
*
Department of Emergency Medicine, University Health Network, Toronto General Hospital, RFE G-S434, 200 Elizabeth St. Toronto ON M5G 2C4; [email protected]

Abstract

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Objective:

We sought to characterize patients who are referred from the emergency department (ED) to specialty clinics but do not complete the referral, and to identify reasons for their failure to follow up.

Methods:

A prospective cohort study was carried out over 3 months of patients who were discharged from the ED of a teaching hospital with referral to internal medicine, cardiology or neurology clinics, but who did not complete the referral. Information on demographics, barriers to care and reasons for not completing the referral was obtained through a standardized telephone interview.

Results:

Of 171 ED referrals, 42 (24.6%) were not completed. Interviews were completed for 71.4% (30 patients). Of the nonattenders, 80% were functional in English and most had high school (73.1%) or university (60.7%) education. Virtually all (93.0%) interviewees could get to hospital by themselves or have someone take them. Only 42.9% (12 patients) understood why the emergency physician (EP) requested consultation, and 42.9% (12 patients) described EP instructions as poor or fair. Primary reasons for noncompletion of consult were patient choice (46.7%, 95% confidence interval [CI] 27.1%–66.2%), physical or social barriers (13.3%, 95% CI 0.0%–27.2%), communication failure (20%, 95% CI 4.0%–36.0%) and consultant's refusal of the consultation (20% [95% CI 4.0%–36.0%]). All consultant refusals were from one internal medicine clinic, representing 42% (8/19) of ED referrals to that clinic. None of the 6 patients interviewed who were declined consultation was aware that their consultation had been refused.

Conclusion:

Patients discharged by the EP with referral to specialty clinics frequently do not complete the consultation. Causes for failure to follow up relate to patient decision, inadequate or poorly understood discharge information, and system factors. Institutional audits of patients who fail to complete follow-up may reveal unanticipated barriers to care.

Keywords

outpatient referralconsultationcontinuity of careemergency departmentdischargecomprehensioncompliance
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 12 , Issue 4 , July 2010 , pp. 325 - 330
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

References

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