Communication breakdown in the outpatient referral process

OBJECTIVE: To evaluate primary care and specialist physicians' satisfaction with interphysician communication and to identify the major problems in th e current referral process. DESIGN: Surveys were mailed to providers to determine satisfaction with the referral process; then patient-specific surveys were e-mailed to this grou p to obtain real-time referral information. SETTING: Academic tertiary care medical center, PARTICIPANTS: Attending-level primary care physicians (PCPs) and specialist s. MEASUREMENTS AND MAIN RESULTS: The response rate for mail surveys for PCPs was 57% and for specialists was 51%. In the mail survey, 63% of PCPs and 35 % of specialists were dissatisfied with the current referral process. Respo ndents felt that major problems with the current referral system were lack, of timeliness of information and inadequate referral letter content. Infor mation considered, important by recipient groups was often not included in letters that were sent, The response rate for the referral specific e-mail surveys was 56% for PCPs and 53% for specialists. In this e-mail survey, 68 % of specialists reported that they received no information from the PCP pr ior to specific referral visits, and 38% of these said that this informatio n would have been helpful. In addition, four weeks after specific referral visits, 25% of PCPs had still not received any information from specialists . CONCLUSIONS: Substantial problems were present in the referral process. The major issues were physician dissatisfaction, lack of timeliness, and inade quate content of interphysician communication. Information obtained from th e general survey and referral-specific survey was congruent. Efforts to imp rove the referral system could improve both physician satisfaction and qual ity of patient care.