Communication Breakdown in the Outpatient Referral Process

Journal of General Internal Medicine (Impact Factor: 3.42). 08/2000; 15(9):626 - 631. DOI: 10.1046/j.1525-1497.2000.91119.x
Source: PubMed Central


OBJECTIVE: To evaluate primary care and specialist physicians' satisfaction with interphysician communication and to identify the major problems in the current referral process.DESIGN: Surveys were mailed to providers to determine satisfaction with the referral process; then patient-specific surveys were e-mailed to this group to obtain real-time referral information.SETTING: Academic tertiary care medical center.PARTICIPANTS: Attending-level primary care physicians (PCPs) and specialists.MEASUREMENTS AND MAIN RESULTS: The response rate for mail surveys for PCPs was 57% and for specialists was 51%. In the mail survey, 63% of PCPs and 35% of specialists were dissatisfied with the current referral process. Respondents felt that major problems with the current referral system were lack of timeliness of information and inadequate referral letter content. Information considered important by recipient groups was often not included in letters that were sent. The response rate for the referral specific e-mail surveys was 56% for PCPs and 53% for specialists. In this e-mail survey, 68% of specialists reported that they received no information from the PCP prior to specific referral visits, and 38% of these said that this information would have been helpful. In addition, four weeks after specific referral visits, 25% of PCPs had still not received any information from specialists.CONCLUSIONS: Substantial problems were present in the referral process. The major issues were physician dissatisfaction, lack of timeliness, and inadequate content of interphysician communication. Information obtained from the general survey and referral-specific survey was congruent. Efforts to improve the referral system could improve both physician satisfaction and quality of patient care.

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Available from: Dean Forrest Sittig, Oct 13, 2015
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    • "The use of electronic referrals and online consultations accelerates the speed of communication and facilitates the logistics. This may reduce the need for patient–consultant meetings [6]. "
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    ABSTRACT: Within the health system, communication between the different levels of care is essential for the patients' clinical pathways and medical treatment. This includes the referral process: how and why patients are sent from the primary care level to specialist health services. We wanted to identify and describe hospital consultants' reflections on and attitudes to the referral process and cooperation with general practitioners (GPs). A qualitative study of semi-structured interviews with 13 hospital consultants representing eight different specialties, analyzed using systematic text condensation. Interviews conducted from February 2011 to October 2012. The consultants reported a considerable workload assessing referrals from GPs and prioritizing patients for specialist services. National guidelines were used as well as individual standards and guidelines. Good referrals could make the prioritization process easier. The specialists expressed a deep concern about securing a fair priority of patients and a willingness to give reasonable advice back to the referring GP when rejecting a referral. Better communication, such as a telephone call to confer with a hospital specialist before referral, was wanted. Better communication and cooperation between hospital consultants and GPs could make the referral process more balanced, and the participants more like partners.
    BMC Family Practice 10/2013; 14(1):153. DOI:10.1186/1471-2296-14-153 · 1.67 Impact Factor
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    • "There is surprisingly little knowledge to guide effective policy setting or practice management in this area. While health information technology can prevent communication breakdowns,47–50 vulnerabilities related to teamwork and care coordination51 52 have received less attention, and novel methods to reduce ambiguities related to these hand-offs are needed. Lastly, EHRs need to be able to support the ‘prospective’ memory53 of providers (memory of an intent to perform a future task) by facilitating alert tracking and self-reminders for future tasks. "
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    ABSTRACT: Context Failure to notify patients of test results is common even when electronic health records (EHRs) are used to report results to practitioners. We sought to understand the broad range of social and technical factors that affect test result management in an integrated EHR-based health system. Methods Between June and November 2010, we conducted a cross-sectional, web-based survey of all primary care practitioners (PCPs) within the Department of Veterans Affairs nationwide. Survey development was guided by a socio-technical model describing multiple inter-related dimensions of EHR use. Findings Of 5001 PCPs invited, 2590 (51.8%) responded. 55.5% believed that the EHRs did not have convenient features for notifying patients of test results. Over a third (37.9%) reported having staff support needed for notifying patients of test results. Many relied on the patient's next visit to notify them for normal (46.1%) and abnormal results (20.1%). Only 45.7% reported receiving adequate training on using the EHR notification system and 35.1% reported having an assigned contact for technical assistance with the EHR; most received help from colleagues (60.4%). A majority (85.6%) stayed after hours or came in on weekends to address notifications; less than a third reported receiving protected time (30.1%). PCPs strongly endorsed several new features to improve test result management, including better tracking and visualization of result notifications. Conclusions Despite an advanced EHR, both social and technical challenges exist in ensuring notification of test results to practitioners and patients. Current EHR technology requires significant improvement in order to avoid similar challenges elsewhere.
    Journal of the American Medical Informatics Association 12/2012; 20(4). DOI:10.1136/amiajnl-2012-001267 · 3.50 Impact Factor
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    • "Deficiencies in communication across health care settings are known to impact the capacity to deliver streamlined follow-up. Delays in information exchange between specialists and primary care physicians and failure to schedule follow-up appointments impact efficacy and adequacy of follow-up care provision (Gandhi et al., 2000; Schoen et al., 2004). Many of these problems have been linked to overstressed primary care services, lack of computerised records or compatible information technology programs for sharing information within and across health care settings and lack Contents lists available at ScienceDirect "
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