Analysis of outpatient referral failures

The purpose of this study was to measure the rate at which outpatient referrals failed to be completed, and to analyze predisposing factors for referral failure in the family practice of a medical center.

Structured questionnaires were completed by referring physicians whenever a referral was initiated during a 4-month period. On the 60th day after referral, an investigator contacted the referred patients by telephone and also reviewed their charts.

During the 4-month period, 604 referrals (2.28%) were made from 26,476 encounters at the study clinic. Sixty-four patients (10.6%) failed to complete the referral processes within a 60-day period. The most frequent reasons for referral failure were administrative factors, ie, too long a wait (59.4%), and the patient's belief that the referral was not necessary (23.4%). The physician's or patients's opinion of referral necessity, the level of experience of the referring physician, and the method of contact with the consultant all had significant influence on the referral failure rate.

Improving administrative efficiency, enhancing communication between physicians and between physicians and patients, assessing the willingness of patients to follow through on a referral, and the method used to initiate the referral by the physician may reduce the referral failure rate.