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The Challenge of Referrals :

November 8, 2019

Referrals play a key role for primary care and subspecialty pediatricians. Those referring hope their patients get appointments in as timely a fashion as possible and those who are consulting hope that patients keep their appointments.

Referrals play a key role for primary care and subspecialty pediatricians. Those referring hope their patients get appointments in as timely a fashion as possible and those who are consulting hope that patients keep their appointments. How often does this really happen? Bohnhoff et al (10.1542/peds.2019-0545) studied this question in an academic health system where primary and urgent care practices were linked to a specialty network to see how often patients got appointments scheduled within a 90-day window, and once scheduled, how often the patients showed up. The authors categorize over 20,000 referrals and found that only 65% got a scheduled appointment in a 90-day window. In addition, they found that a little over 50% of the time patients attended the scheduled referral. If the appointment time from referral to appointment exceeded 7 days or more, the likelihood of the patient keeping the appointment decreased.

Do these findings sound familiar to your local practice environment? The results of this study might even be better than what you experience, since the primary care offices and subspecialty referral practices in the study were part of the same health system, making the referral process easier.

Why is the referral process so challenging? We asked Dr. Suzanne Berman to weigh in with an accompanying commentary (10.1542/peds.2019-2975). She notes barriers ranging from working parents unable to get away from work sooner for a scheduled appointment as well as parents not answering reminder phone calls. She also notes other factors such as distribution of subspecialists in some geographic areas where there is an undersupply and thus long waits for appointments. Dr. Berman offers some suggestions as well for what might improve the referral delay in scheduling or in keeping appointments. I would encourage you to make an appointment and check out this study and commentary and decide if you cannot implement some improvements suggested in these articles in the referral pathways you use for your patients.

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