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.
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.
Authors: Gregory J Fermann; Phillip D Levy; Peter Pang; Javed Butler; S Imran Ayaz; Douglas Char; Patrick Dunn; Cathy A Jenkins; Christy Kampe; Yosef Khan; Vijaya A Kumar; JoAnn Lindenfeld; Dandan Liu; Karen Miller; W Frank Peacock; Samaa Rizk; Chad Robichaux; Russell L Rothman; Jon Schrock; Adam Singer; Sarah A Sterling; Alan B Storrow; Cheryl Walsh; John Wilburn; Sean P Collins Journal: Circ Heart Fail Date: 2017-02 Impact factor: 8.790
Authors: David D Stenehjem; Trang Au; Amy M Sainski; Hillevi Bauer; Krystal Brown; Johnathan Lancaster; Vanessa Stevens; Diana I Brixner Journal: BMC Health Serv Res Date: 2018-03-07 Impact factor: 2.655
Authors: Joseph K Agor; Mustafa Y Sir; Kalyan S Pasupathy; David A Foley; Christopher G Scott; Muhamad Y Elrashidi; Nathan P Young; Paul M McKie Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2019-10-22
Authors: Nicholas Prudhomme; Edmund S H Kwok; Laura Olejnik; Shannon White; Venkatesh Thiruganasambandamoorthy Journal: Emerg Med Int Date: 2019-10-31 Impact factor: 1.112