title: Improving care: a study of orthopaedic outpatient referrals.
abstract: OBJECTIVE
  To identify aspects of outpatient referral in which general practitioners', consultants', and patients' satisfaction could be improved.
  
  
  METHODS
  Questionnaire survey of general practitioners, consultant orthopaedic surgeons, and patients referred to an orthopaedic clinic.
  
  
  METHODS
  Orthopaedic clinic, Doncaster Royal Infirmary.
  
  
  METHODS
  628 consecutive patients booked into the orthopaedic clinic.
  
  
  METHODS
  Views of the general practitioners as recorded both when the referral letter was received and again after the patient had been seen, views of the consultants as recorded at the time of the clinic attendance, and views of the patients as recorded immediately after the clinic visit and some time later.
  
  
  RESULTS
  Consultants rated 213 of 449 referrals (42.7%) as possibly or definitely inappropriate, though 373 of 451 patients (82.7%) reported that they were helped by seeing the consultant. Targets for possible improvement included information to general practitioners about available services, communication between general practitioners and consultants, and administrative arrangements in clinics. Long waiting times were a problem, and it seemed that these might be reduced if general practitioners could provide more advice on non-surgical management. Some general practitioners stated that they would value easier telephone access to consultants for management advice. It was considered that an alternative source of management advice on musculoskeletal problems might enable more effective use to be made of specialist orthopaedic resources. Conclusion--A survey of patients' and doctors' views of referrals may be used to identify aspects in which the delivery of care could be made more efficient. Developing agreed referral guidelines might help general practitioners to make more effective use of hospital services.
authors.affiliation: Cambridge University School of Clinical Medicine, Addenbrooke's Hospital.
authors.forename: M O
authors.initials: MO
authors.lastname: Roland
authors.forename: R W
authors.initials: RW
authors.lastname: Porter
authors.forename: J G
authors.initials: JG
authors.lastname: Matthews
authors.forename: J F
authors.initials: JF
authors.lastname: Redden
authors.forename: G W
authors.initials: GW
authors.lastname: Simonds
authors.forename: B
authors.initials: B
authors.lastname: Bewley
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D003258:Consumer Behavior / Q000706:statistics & numerical data*; D004739:England; D005194:Family Practice; D006297:Health Services Accessibility; D006801:Humans; D008330:Management Audit; D009985:Orthopedics / Q000592:standards*; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D012017:Referral and Consultation / Q000592:standards*; D011795:Surveys and Questionnaires; D014850:Waiting Lists