DISCREPANCIES BETWEEN THE ASSESSED URGENCY AND THE ACTUAL TIME TAKEN TO OBTAIN A CONSULTATION WITH AN INTERNIST

Objective - To compare postreferral waiting times to hospital in inter nal medicine with the urgency of the cases as assessed by a panel of d octors. Design-Retrospective evaluation of referrals to three hospital s during 1 week.Setting - Referrals to internal medicine departments o f Kuopio University Hospital, Kajaani central hospital and Pieksamaki regional hospital in Finland. Participants - Two specialists in intern al medicine working in university hospital and four specialists in gen eral practice, two of whom were private sector general practitioners ( GPs), the other two being public health centre chief physicians. Outco me measures - Postreferral waiting times, assessment of the urgency of the referral by a panel of doctors, and the reliability of this asses sment. Results - Mean delay to specialist consultation was 36 days. Th ere were no significant differences between the assessors in their opi nions regarding the degree of urgency of referrals. Interobserver agre ement between assessors was moderate or substantial (kappa values 0.46 -0.62) and intraobserver agreement varied from moderate to almost perf ect (kappa values were between 0.57 and 0.88). However, of those patie nts who were assessed to require examination by a consultant within 1 week only 34% actually saw the specialist within that time. Of those p atients who were assessed to be require the treatments within 8-30 day s, 48% were examined by a specialist within that time. Conclusion - It is possible to reliably assess the urgency of referrals to internal m edicine departments. There is a need to improve the referral process f or those patients requiring consultation with a hospital specialist wi thin 30 days.