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

Am J Emerg Med. 2013 Oct;31(10):1495-500. doi: 10.1016/j.ajem.2013.08.007. Epub 2013 Sep 10.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Continuity of Patient Care / organization & administration
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Insurance Coverage / statistics & numerical data
  • Insurance, Health / statistics & numerical data
  • Male
  • Medicine / organization & administration*
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Patient Compliance / statistics & numerical data
  • Quality Improvement / organization & administration*
  • Quality of Health Care / organization & administration
  • Referral and Consultation / organization & administration*
  • Retrospective Studies
  • Time Factors
  • Young Adult