Assessment of referrals to a multidisciplinary outpatient clinic for patients with back pain

Abstract

ObjectiveEach year our multidisciplinary outpatient clinic for patients with back pain receives a large number of referrals from primary care physicians, manual physiotherapists, and chiropractors. We wanted to assess the quality of the referrals regarding the information provided about case history, clinical findings, and results from additional investigations.Material and methodsTwo hundred and eighty six consecutive referrals received in the time period from 1 October 2008 to 1 March 2009 were reviewed. We investigated if the referrals contained 12 given items. The items were defined by consensus of the broad range of specialists working at the multidisciplinary outpatient clinic. All registered items were regarded as useful when assigning patients with a priority and appropriate caregiver at the outpatient clinic. The 12 items that our group felt were reflective of good referrals were information about occupational status, duration of symptoms, pain distribution, sensory symptoms, use of analgesics, alleviating and/or aggravating factors, systems enquiry (i.e. urination, bowel movements, and sleep), provided treatment, deep tendon reflexes, motor function, sensory examination, and radiculopathy tests (i.e. straight leg raise and/or foraminal compression test).ResultsTwo hundred and fifty six (89·5%) referrals were from primary care physicians, and the remaining came from physicians in internships, manual physiotherapists, and chiropractors. Six (2·1%) referrals contained all 12 items. On average each referral contained 5·95 items (95% CI: 5·66–6·25). Information about analgesics, sensory symptoms, systems enquiry, and alleviating and aggravating factors was most frequently missing. Information about provided treatment, motor function, deep tendon reflexes, clinical tests, and occupational status was included in about half of the referrals. In 27·3% of the referrals from primary care physicians information about clinical findings was missing. Referrals from manual physiotherapists contained statistically significant more information (9·67 items, 95% CI: 7·63–11·70) than from the other groups (P<0·001). The number of patients registered with each primary care physician did not affect the number of items in the referrals.ConclusionMany of the referrals were inadequate. Inadequate referrals can lead to prolonged waiting time for examination and treatment. Referrals with relevant information about patient history and clinical findings are essential in order to assign patients with an appropriate caregiver at the outpatient clinic and to determine if and which diagnostic imaging findings are of clinical relevance.

Healthcare professionals’ proposed eHealth needs in elective primary fast‐track hip and knee arthroplasty journey: A qualitative interview study

“…The healthcare professionals interviewed suggested that referrals should be structured and include mandatory fields to be completed prior to a referral being sent to hospital. As has been shown in the previous literature, important information is currently missing from referrals (Gulati et al, 2012). Incomplete referrals can lead to a prolonged waiting time for examination and treatment, and they also impinge upon the hospital's ability to process referrals.…”

Rettighetsvurdering og kvalitet på henvisninger – grad av samsvar mellom fire smertesentre

“…Flere studier har vist at henvisninger til spesialisthelsetjenesten er av varierende kvalitet (7)(8)(9)(10)(11)(12). Lønning og medarbeidere (2009) fant at en tredjedel av 198 innkommende henvisninger til medisinsk poliklinikk ved Sykehuset Buskerud var mangelfulle (7).…”

“…Lønning og medarbeidere (2009) fant at en tredjedel av 198 innkommende henvisninger til medisinsk poliklinikk ved Sykehuset Buskerud var mangelfulle (7). I en evaluering av 256 henvisninger til tverrfaglig ryggpoliklinikk ved St. Olavs hospital fant Gulati og medarbeidere (2012) at kun 2,1 % inneholdt informasjon som dekket antatt viktige kategorier (8).…”

“…Vurdering av innholdet i henvisningene viste at 7 av 16 informasjonskategorier i stor grad ikke var tilstrekkelig beskrevet, og inntaksteamene vurderte kvaliteten på naer halvparten av henvisningene som «ikke god». Disse funnene samsvarer med tidligere studier (7,8,10) og bekrefter inntrykket av at henvisninger i mange tilfeller ikke holder god nok kvalitet og ofte mangler vesentlig informasjon for å foreta adekvat rettighetsvurdering i spesialisthelsetjenesten.…”

European panel on the appropriateness of gastrointestinal endoscopy II guidelines help in selecting and prioritizing patients referred to colonoscopy – a quality control study

“…Unsatisfactory quality of the referral letters has been a frequent finding in the literature, although the reporting methods and the studied specialties are fairly heterogeneous (5, 6, 63, 65-71, 74, 96-110). Missing information have been reported in between 37% (63) and 98% (96) of referrals, and the most frequently missing information is reported in pre-referral work-up/examinations (63,67,69,70), medications (63,65,69,98,109,110) and details regarding the current disease (63,65,74,96,103,109). Maxillofacial unit, ranging from 7% to 67% missing data for the different information items (101).…”