Today’s Referral Is Tomorrow’s Repeat Patient: Referrals Between Medical Outpatient Clinics in a Hospital

Background: Lack of understanding of inter-department and inter-speciality referral processes in Danish hospitals is contributing to unnecessary referrals and inefficient use of a health service already stretched and under pressure. An inefficient referral process is associated with over testing and repetitive testing, delayed treatment, patient confusion, ineffective use of physician and hospital service, and impaired patient outcomes. Despite a growing awareness in the literature and in practice of issues related to referrals, there has been relatively little research on referrals between specialists in hospital outpatient clinics and how it can be improved. This study aimed to describe the referral patterns to and within the Medical Department at the University Hospital of Southern Denmark. The Medical Department consists of the following medical specialist outpatient clinics: nephrology, pulmonology, endocrinology, cardiovascular, wound outpatient clinic, and a day hospital. Methods: Two specialist physicians assessed all referrals to the medical specialist outpatient clinics over one month (from 01 September 2019 to 30 September 2019) using data drawn from the Danish electronic patient record system (Cosmic). Data on referral pattern, and patient age and sex, were statistically analysed to identify and characterise patterns of referral. Results: 471(100%) referrals were included in the study. 49.5 % (233) of the referrals were from the hospital and 50.5 % (238) from general practitioners (GPs). Of the 233 referrals from the hospitals, 31% (72) were from the Medical Department. Conclusion: The high rate of referrals from hospitals and referrals from own Medical Department or outpatient clinics illustrates the need for improvement on the inter-department referral process to provide joint care for multi-morbidity patients managed in multiple hospital outpatient clinics. Improved collaboration between specialists has the potential to improve health outcomes, timely access to care and more appropriate healthcare resource utilisation.