Referring Provider-Specialist Diagnostic Concordance in Pediatric Urology

Diagnoses provided by referring physicians are utilized to assess clinical acuity and triage scheduling. Lack of concordance between the referring provider and the consultant may result in inappropriate prioritization of patients, inefficient clinic flow, and delays in care. We undertook this study to describe concordance in referring and consultant diagnoses in a pediatric urology clinic.

We performed a retrospective review of all new urology patients referred to outpatient clinic visits at a single freestanding tertiary care children's hospital from January 2022 to December 2023. We collected patients' demographics, provider type (advanced practice provider or physician), provider location, and referring and consulting diagnoses. Data were compared using chi-square tests and odds ratios.

We identified 2608 unique patients, of whom 451 (17.3%) had discordant diagnoses. A total of 988 (37.9%) had diagnostic agreement between the referring provider and urologist for a single diagnosis, 292 (11.2%) had diagnostic disagreement between the referring provider and urologist for a single diagnosis, 1169 (44.8%) had diagnostic agreement between the referring provider and urologist with additional diagnoses added by the urologist, and 159 (6.1%) had disagreement between the referring provider and urologist with additional diagnoses added by the urologist. The most common single diagnoses for which there was diagnostic disagreement were undescended testes (n = 138), circumcision consultation/uncircumcised male (n = 21), and unspecified disorder of male genital tract (n = 32). All patients with phimosis with diagnostic differences had more specific findings noted by the urologist such as chordee, penile adhesions, or penile torsion. This was also the case for patients sent with an unspecified diagnosis, all of whom received a more specific diagnosis. Phimosis/request for circumcision (n = 37) and undescended testes (n = 31) were also the most common diagnoses on which the referring provider and urologist disagreed.

A minority of referrals to pediatric urology show diagnostic disagreement between the referring provider and urologist, though urologists report additional diagnoses in nearly half of referrals. Most diagnostic disagreement occurs in referrals for elective circumcision and undescended testes, suggesting that these topics may be target areas for education in primary care. Urologists' addition of diagnoses, despite agreement with the referral diagnosis, may reflect more detailed evaluation or a need for more specific specialty documentation and is an area for further study.