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Communication breakdown in the outpatient referral process


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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Correspondence to David W. Bates MD, MSc.

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Gandhi, T.K., Sittig, D.F., Franklin, M. et al. Communication breakdown in the outpatient referral process. J GEN INTERN MED 15, 626–631 (2000).

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Key Words

  • ambulatory care
  • communication
  • referral and consultation