Factors Associated With Difficult Emergency Department Referral: A Cross-Sectional Study

Emergency department (ED) referrals are an essential component of patients' care. According to the reviewed literature, ED referrals to other specialties frequently encounter difficulties. Nonetheless, the specific challenges of the Saudi context have not received adequate attention.

A cross-sectional study of emergency physicians in Riyadh City was conducted through a questionnaire using Google Forms. We gathered data on sociodemographic, referral practices, awareness, and difficulties. Data were analyzed using descriptive statistics and chi-square tests, with a significance level of 0.05.

Of the 104 participants, the majority (94, 90.4%) reported difficulty with referrals. The most common reasons for referral difficulties are the following: 86 (82.7%) report that consultants are being asked to refer patients to other specialties before seeing them in person, 79 (76.0%) refuse referrals due to "endorsement time," and 76 (73.1%) request further tests. Unexpectedly, 62 (59.6%) of the participants reported verbal assault. On the other hand, there was a strong relationship between gender and referral difficulties, with 27 (100%) of female physicians reporting challenges versus 67 (87%) of male physicians (p=0.049). In addition, 39 (37.5%) study participants had no formal training in effective referrals. We also noticed that the majority of the difficulties occurred during the night and weekend shifts (61, 58.7%, and 54, 51.9%, respectively).

The most obvious reasons are consulting physicians ordering additional labs or images, or asking to refer the patient to another specialty before seeing them. In addition, consulting physician endorsement time was an issue. Furthermore, referral difficulties occur more frequently during night shifts and weekends. To mitigate these difficulties, all training programs should include communication and training skills. Policies of consultation or referral should be enforced. Additionally, the emergency physician should be able to schedule outpatient appointments with the required specialty. Moreover, the receiving consultant should be a senior physician. Referral difficulties should be minimized to improve patient care, outcomes, and satisfaction.