Clinic follow-up from the emergency department: do patients show up?

We examined the percentage of outpatient clinic appointments kept after referral from the emergency department. Several factors (age, sex, and specialty) were examined, to determine their effect on patient compliance.

This study was a retrospective review of the 503 appointments made in the orthopedic surgery, plastic surgery, gynecology, and urology clinics at Victoria General Hospital (VGH), Halifax, Nova Scotia, Canada, between January 1 and March 31, 1995, that were referred from the VGH ED. VGH is a 600-bed adult teaching hospital with 46,000 emergency visits each year. The patients ranged in age from 15 to 92 years. All of the patients were seen in the VGH ED and referred to an outpatient clinic in the VGH.

Overall, 81.7% of appointments were kept. Orthopedic surgery had the best compliance rate (86.7%), gynecology the poorest (60.6%). Compliance rates increased with age, and male patients had a higher compliance rate than female patients. The average time between ED visit and outpatient appointment was 7.9 days, and 59.4% of the patients referred were male.

The compliance rate at VGH is higher than any found in studies of similar American hospitals. We determined two main explanations for this phenomenon: (1) the ED clerk makes the outpatient clinic appointment before the patient leaves the ED and gives the patient a computer printout of the date and time of the appointment and a map with the location of the appointment circled, and (2) patients do not have to pay for outpatient clinic visits.