A Health Records Review of Outpatient Referrals from the Emergency Department
Objectives. Many patients discharged home from the emergency department (ED) require urgent outpatient consultation with a specialty service. We sought to identify the best- and worst-performing services with regard to time to outpatient consultation, the proportion of patients lost to follow-up, th...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Emergency Medicine International |
| Online Access: | http://dx.doi.org/10.1155/2019/5179081 |
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| author | Nicholas Prudhomme Edmund S. H. Kwok Laura Olejnik Shannon White Venkatesh Thiruganasambandamoorthy |
| author_facet | Nicholas Prudhomme Edmund S. H. Kwok Laura Olejnik Shannon White Venkatesh Thiruganasambandamoorthy |
| author_sort | Nicholas Prudhomme |
| collection | DOAJ |
| description | Objectives. Many patients discharged home from the emergency department (ED) require urgent outpatient consultation with a specialty service. We sought to identify the best- and worst-performing services with regard to time to outpatient consultation, the proportion of patients lost to follow-up, the rate of related return ED visits prior to consultation, and common strategies used by our top-performing clinics. Methods. We conducted a health records review of The Ottawa Hospital ED visits during four 1-week periods. All consecutive adult outpatient consultation requests were included for chart review and were followed up to 12 months. Outcome measures included demographics, referral attendance rates, incomplete referrals, return ED visits, and time intervals. Services with at least 15 consultation requests were included for data analysis and qualitative mapping of their referral processes. Results. Of the 963 patients who met inclusion criteria, 803 (83.4%) attended their appointment, while 160 (16.6%) were lost to follow-up. The overall median time to successful consultation was 9 days (IQR = 2–27). 92 (9.6%) patients returned to the ED with a related complaint. The top-performing clinics included ophthalmology, orthopedics, and thrombosis (median = 1, 8, 1 days; incomplete consultation = 3%, 4%, 6%; return ED visits = 0%, 6%, 2% respectively). The bottom-performing clinics included otorhinolaryngology, neurology, and gynecology (median = 47, 39, 27 days; incomplete consultation = 50%, 41%, 37%; return ED visits = 11%, 15%, 26%, respectively). Processes incorporated by top-performing clinics included reserving appointment slots for emergency referrals, structured referral forms, and centralized booking. Conclusions. We found a substantial variability in both the waiting times and reliability of outpatient referrals from the ED. Top-performing clinics incorporate common referral processes. |
| format | Article |
| id | doaj-art-2e16b52fdda14b01b246d99573d4f75d |
| institution | Kabale University |
| issn | 2090-2840 2090-2859 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Emergency Medicine International |
| spelling | doaj-art-2e16b52fdda14b01b246d99573d4f75d2025-08-20T03:55:07ZengWileyEmergency Medicine International2090-28402090-28592019-01-01201910.1155/2019/51790815179081A Health Records Review of Outpatient Referrals from the Emergency DepartmentNicholas Prudhomme0Edmund S. H. Kwok1Laura Olejnik2Shannon White3Venkatesh Thiruganasambandamoorthy4Department of Emergency Medicine, University of Ottawa, Ottawa, ON, CanadaDepartment of Emergency Medicine, University of Ottawa, Ottawa, ON, CanadaDepartment of Emergency Medicine, University of Ottawa, Ottawa, ON, CanadaDepartment of Emergency Medicine, University of Ottawa, Ottawa, ON, CanadaDepartment of Emergency Medicine, University of Ottawa, Ottawa, ON, CanadaObjectives. Many patients discharged home from the emergency department (ED) require urgent outpatient consultation with a specialty service. We sought to identify the best- and worst-performing services with regard to time to outpatient consultation, the proportion of patients lost to follow-up, the rate of related return ED visits prior to consultation, and common strategies used by our top-performing clinics. Methods. We conducted a health records review of The Ottawa Hospital ED visits during four 1-week periods. All consecutive adult outpatient consultation requests were included for chart review and were followed up to 12 months. Outcome measures included demographics, referral attendance rates, incomplete referrals, return ED visits, and time intervals. Services with at least 15 consultation requests were included for data analysis and qualitative mapping of their referral processes. Results. Of the 963 patients who met inclusion criteria, 803 (83.4%) attended their appointment, while 160 (16.6%) were lost to follow-up. The overall median time to successful consultation was 9 days (IQR = 2–27). 92 (9.6%) patients returned to the ED with a related complaint. The top-performing clinics included ophthalmology, orthopedics, and thrombosis (median = 1, 8, 1 days; incomplete consultation = 3%, 4%, 6%; return ED visits = 0%, 6%, 2% respectively). The bottom-performing clinics included otorhinolaryngology, neurology, and gynecology (median = 47, 39, 27 days; incomplete consultation = 50%, 41%, 37%; return ED visits = 11%, 15%, 26%, respectively). Processes incorporated by top-performing clinics included reserving appointment slots for emergency referrals, structured referral forms, and centralized booking. Conclusions. We found a substantial variability in both the waiting times and reliability of outpatient referrals from the ED. Top-performing clinics incorporate common referral processes.http://dx.doi.org/10.1155/2019/5179081 |
| spellingShingle | Nicholas Prudhomme Edmund S. H. Kwok Laura Olejnik Shannon White Venkatesh Thiruganasambandamoorthy A Health Records Review of Outpatient Referrals from the Emergency Department Emergency Medicine International |
| title | A Health Records Review of Outpatient Referrals from the Emergency Department |
| title_full | A Health Records Review of Outpatient Referrals from the Emergency Department |
| title_fullStr | A Health Records Review of Outpatient Referrals from the Emergency Department |
| title_full_unstemmed | A Health Records Review of Outpatient Referrals from the Emergency Department |
| title_short | A Health Records Review of Outpatient Referrals from the Emergency Department |
| title_sort | health records review of outpatient referrals from the emergency department |
| url | http://dx.doi.org/10.1155/2019/5179081 |
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