Improving specialty care follow-up after an ED visit using a unique referral system

• Published in: The American journal of emergency medicine Vol. 31; no. 10; pp. 1495 - 1500
• Main Authors: Messina, Frank C., MD, McDaniel, Michele A., MD, Trammel, Adam C., MD, Ervin, Denise R., MBA, Kozak, Mary Ann, DrPH, Weaver, Christopher S., MD, MBA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2013; Elsevier Limited
• Subjects: Adolescent; Adult; Age Factors; Aged; Benchmarks; Charities; Clinics; Confidence intervals; Continuity of Patient Care - organization & administration; Emergency; Emergency medical care; Emergency Service, Hospital; Ethnicity; Female; Health care access; Hospitals; Humans; Indigent care; Insurance Coverage - statistics & numerical data; Insurance, Health - statistics & numerical data; Male; Medicare; Medicine - organization & administration; Middle Aged; Neurology; Neurosurgery; Otolaryngology; Outcome and Process Assessment (Health Care); Patient Compliance - statistics & numerical data; Patient Protection & Affordable Care Act 2010-US; Patient safety; Patients; Physicians; Plastic surgery; Primary care; Quality Improvement - organization & administration; Quality of Health Care - organization & administration; Referral and Consultation - organization & administration; Regression analysis; Retrospective Studies; Time Factors; Young Adult
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2013.08.007

Abstract Objective Many patients discharged from the emergency department (ED) require urgent follow-up with specialty providers. We hypothesized that a unique specialty referral mechanism that minimized barriers would increase follow-up compliance over reported and historical benchmarks. Methods Retrospective review of all patients requiring urgent (within 1 month) specialty referrals in 2010 from a safety net hospital ED to dermatology, otolaryngology, neurology, neurosurgery, ophthalmology, urology, plastic surgery, general surgery, or vascular surgery clinics. After specialist input, all patients received a specific follow-up appointment before ED discharge via a specific scheduling service. Necessity for payment at the follow-up visit was waived. Results Of the 1174 receiving referrals, 85.6% of patients scheduled an appointment and 80.1% kept that appointment. After logistic regression analysis, the factors that remained significantly associated ( P < .05) with appointment-keeping compliance were the specialty clinic type (dermatology, 61.5%, to ophthalmology, 98.0%), insurance status (other payer, 87.5%; commercial, 82.8%; Medicaid, 77.9%; Medicare, 85.7%; charity care program, 88.1%; self-pay, 73.0%), age (< 18 years, 80.1%; 18-34 years, 75.0%; 35-49 years, 79.2%; 50-64 years, 85.9 %; > 64 years, 93.9%), and mean length of time between ED visit and clinic appointment (kept, 10.5 days; not kept, 14.3 days). The specialty clinic (neurology, 72.8%, to vascular surgery, 100%; P < .001) was significantly associated with the likelihood of patients to complete the appointment-making process. Race/Ethnicity was not associated with either scheduling or keeping an appointment. Conclusion A referral process that minimizes barriers can achieve an 80% follow-up compliance rate. Age, insurance, specialty type, and time to appointment are associated with noncompliance.