Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-19T23:48:59.380Z Has data issue: false hasContentIssue false
  • English
  • Français

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; steven.friedman@uhn.on.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
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

REFERENCES

1.Stone, CA., Palmer, JH, Saxby, PJ, et al.Reducing nonattendance at outpatient clinics. JR SocMed 1999;92:114–8.Google ScholarPubMed
2.Gallucci, G, Swartz, W, Hackerman, F. Impact of the wait for an initial appointment on the rate of kept appointments at a mental health center. Psychiatr Serv 2005;56:344–6.Google Scholar
3.Lee, VJ, Earnest, A, Chen, MI, et al.Predictors of failed attendances in a multispecialty outpatient centre using electronic databases. BMC Health Serv Res 2005;5:51.CrossRefGoogle Scholar
4.Kyriacou, DN, Handel, D, Stein, AC, et al.Brief report: factors affecting outpatient follow-up compliance of emergency department patients. J Gen Intern Med 2005;20:938–42.CrossRefGoogle ScholarPubMed
5.Vukmir, RB, Kremen, R, Dehart, DA, et al.Compliance with emergency department patient referral. Am J Emerg Med 1992;10:413–7.CrossRefGoogle ScholarPubMed
6.Murray, MJ, LeBlanc, CH. Clinic follow-up from the emergency department: Do patients show up? Ann Emerg Med 1996;27:56–8.Google Scholar
7.Sarver, J, Baker, DW. Effect of language barriers on follow-up appointments after an emergency department visit. J Gen Intern Med 2000;15:256–64.CrossRefGoogle ScholarPubMed
8.Clarke, C, Friedman, SM, Shi, K, et al.Emergency department discharge instructions comprehension and compliance study. CJEM 2005;7:5–11.Google Scholar
9.Thomas, EJ, Burstin, HR, O’Neil, AC, et al.Patient noncompliance with medical advice after the emergency department visit. Ann Emerg Med 1996;27(Issue 1):49–55.CrossRefGoogle ScholarPubMed
10.Wojtowicz, JM, Dowling, S, Nanji, AM, et al.Patient adherence with emergency department referral to a cardiovascular evaluation and risk assessment clinic. CJEM 2008;10:511–7.Google ScholarPubMed
11.Engel, KG, Helsler, M, Smith, DM, et al.Patient comprehension of emergency department care and instructions: Are patients aware of when they do not understand? Ann Emerg Med.2009;53:454–61.CrossRefGoogle Scholar
12.Komoroski, EM, Graham, CJ, Kirby, RS. A comparison of interventions to improve clinic follow-up compliance after a pediatric emergency department visit. Pediatr Emerg Care 1996;12:87–90.Google Scholar
13.Richards, D, Meshkat, N, Chu, J, et al.Emergency department patient compliance with follow-up for outpatient exercise stress testing: a randomized controlled trial. CJEM 2007;9:435–40.CrossRefGoogle ScholarPubMed