Follow-up Actions on Electronic Referral Communication in a Multispecialty Outpatient Setting
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Electronic health records (EHR) enable transmission and tracking of referrals between primary-care practitioners (PCPs) and subspecialists. We used an EHR to examine follow-up actions on electronic referral communication in a large multispecialty VA facility.
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.
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.
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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- Follow-up Actions on Electronic Referral Communication in a Multispecialty Outpatient Setting
Journal of General Internal Medicine
Volume 26, Issue 1 , pp 64-69
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- primary care
- sub-specialty care
- electronic health records
- patient safety
- health information technology
- diagnostic errors
- patient follow-up
- Industry Sectors
- Author Affiliations
- 1. Houston VA HSR&D Center of Excellence and The Center of Inquiry to Improve Outpatient Safety Through Effective Electronic Communication, Michael E. DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Houston, TX, USA
- 2. Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- 3. University of Texas School of Health Information Sciences and the UT-Memorial Hermann Center for Healthcare Quality & Safety, Houston, TX, USA
- 4. Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX, USA
- 5. Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA