Referral processes and wait times in primary care

Ieva Neimanis; Kathryn Gaebel; Robert Dickson; Richard Levy; Cindy Goebel; Angelo Zizzo; Anne Woods; John Corsini

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Table 1.

Requests for referrals

SPECIALTY	TOTAL REFERRALS, N (%)	REFERRALS WITH NO RESPONSE, N (%)
Overall	770 (100.0)	280 (36.4)
All surgeons	95 (12.3)	36 (37.9)
Allergy	54 (7.0)	13 (24.1)
Audiology	10 (1.3)	1 (10.0)
Bariatric	9 (1.2)	4 (44.4)
Cardiology	39 (5.1)	11 (28.2)
Dermatology	117 (15.2)	14 (12.0)
Endocrinology	7 (0.9)	3 (42.9)
ENT	55 (7.1)	25 (45.5)
Gastroenterology	73 (9.5)	32 (43.8)
Geriatrics	1 (0.1)	1 (100.0)
Hematology	7 (0.9)	3 (42.9)
Infectious diseases	2 (0.3)	0 (0.0)
Internal medicine	6 (0.8)	3 (50.0)
Nephrology	5 (0.6)	3 (60.0)
Neurology	25 (3.2)	9 (36.0)
OB-GYN	57 (7.4)	24 (42.1)
Ophthalmology	9 (1.2)	5 (55.6)
Orthopedics	58 (7.5)	25 (43.1)
Pain management	6 (0.8)	5 (83.3)
Palliative care	1 (0.1)	1 (100.0)
Pediatrics	24 (3.1)	14 (58.3)
Physical medicine	21 (2.7)	12 (57.1)
Psychiatry	7 (0.9)	5 (71.4)
Respiratory	21 (2.7)	13 (61.9)
Rheumatology	21 (2.7)	3 (14.3)
Sleep clinic	8 (1.0)	4 (50.0)
Urology	32 (4.2)	11 (34.4)

ENT—ear, nose, and throat; OB-GYN—obstetrics and gynecology.

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Table 2.

Outcome of referral

OUTCOME	VALUE, N (%)
Positive
• Patient received appointment	464 (60.3)
• Patient went to ED	1 (0.1)
• Total	465 (60.4)
Negative
• No response to request	280 (36.4)
• Referral declined	13 (1.7)
• Patient to contact office, or office to contact patient	12 (1.6)
• Total	305 (39.6)

ED—emergency department.

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Table 3.

Time asking question to response and appointment

SPECIALTY	RESPONSES WITHIN 2 WEEKS, N (%)	MEAN (95% CI) DAYS TO RESPOND	MEAN (95% CI) DAYS TO PATIENT APPOINTMENT
Overall	375 (82.8)	7.8 (6.9 to 8.6)	60.1 (54.7 to 65.5)
All surgeons	51 (100.0)	6.8 (4.4 to 9.2)	63.3 (45.8 to 80.8)
Allergy	40 (100.0)	4.2 (3.1 to 5.2)	105.9 (80.7 to 131.0)
Audiology	9 (100.0)	3.6 (1.6 to 5.6)	48.3 (21.8 to 74.9)
Bariatric	4 (100.0)	10.0 (−26.6 to 46.6)	23.3 (−24.0 to 70.6)
Cardiology	22 (84.6)	6.5 (4.5 to 8.6)	38.8 (28.2 to 49.4)
Dermatology	94 (95.9)	4.9 (3.8 to 6.0)	41.0 (31.8 to 50.1)
Endocrinology	4 (100.0)	4.5 (−2.7 to 11.7)	61.3 (4.4 to 118.1)
ENT	21 (70.0)	11.3 (6.6 to 16.0)	81.4 (59.2 to 103.5)
Gastroenterology	30 (75.0)	41.0 (0.0 to 148.0)	54.5 (41.3 to 67.6)
Geriatrics	0 (0.0)	No data	No data
Hematology	4 (100.0)	21.3 (5.4 to 37.1)	106.0 (−19.5 to 231.5)
Infectious diseases	2 (100.0)	5.0	168.5 (−1654.8 to 1991.8)
Internal medicine	1 (33.3)	No data	42.0
Nephrology	0 (0.0)	28.0	167.0
Neurology	6 (42.9)	15.4 (8.9 to 21.8)	110.0 (59.0 to 161.0)
OB-GYN	16 (57.2)	14.8 (10.1 to 19.5)	69.1 (47.3 to 90.9)
Ophthalmology	4 (100.0)	2.8 (−1.0 to 6.5)	32.0 (14.7 to 49.3)
Orthopedics	25 (75.8)	7.5 (4.6 to 10.5)	37.7 (27.4 to 48.0)
Pain management	0 (0.0)	No data	No data
Palliative care	0 (0.0)	No data	No data
Pediatrics	7 (77.8)	6.4 (−0.04 to 12.9)	43.4 (7.3 to 79.6)
Physical medicine	5 (71.4)	6.5 (0.6 to 12.4)	29.3 (14.3 to 44.4)
Psychiatry	2 (100.0)	1.0	42.0
Respiratory	6 (100.0)	4.2 (−1.6 to 10.0)	38.6 (−6.6 to 83.5)
Rheumatology	12 (70.6)	10.2 (6.5 to 13.9)	57.9 (35.9 to 79.8)
Sleep clinic	0 (0.0)	32.5 (0.7 to 64.3)	48.5 (16.7 to 80.3)
Urology	18 (90.0)	5.5 (1.9 to 9.1)	64.0 (40.0 to 88.4)