Discrepancies between the assessed urgency and the actual time taken to obtain a consultation with an internist.
OBJECTIVE
To compare postreferral waiting times to hospital in internal medicine with the urgency of the cases as assessed by a panel of doctors.


METHODS
Retrospective evaluation of referrals to three hospitals during 1 week.


METHODS
Referrals to internal medicine departments of Kuopio University Hospital, Kajaani central hospital and Pieksämäki regional hospital in Finland.


METHODS
Two specialists in internal medicine working in university hospital and four specialists in general practice, two of whom were private sector general practitioners (GPs), the other two being public health centre chief physicians.


METHODS
Postreferral waiting times, assessment of the urgency of the referral by a panel of doctors, and the reliability of this assessment.


RESULTS
Mean delay to specialist consultation was 36 days. There were no significant differences between the assessors in their opinions regarding the degree of urgency of referrals. Interobserver agreement between assessors was moderate or substantial (kappa values 0.46-0.62) and intraobserver agreement varied from moderate to almost perfect (kappa values were between 0.57 and 0.88). However, of those patients who were assessed to require examination by a consultant within 1 week only 34% actually saw the specialist within that time. Of those patients who were assessed to be require the treatments within 8-30 days, 48% were examined by a specialist within that time.


CONCLUSIONS
It is possible to reliably assess the urgency of referrals to internal medicine departments. There is a need to improve the referral process for those patients requiring consultation with a hospital specialist within 30 days.
Department of Community Health and General Practice, University of Kuopio, Finland.
A T
AT
Vehviläinen
I J
IJ
Vohlonen
E A
EA
Kumpusalo
J K
JK
Takala
D004630:Emergencies; D005260:Female; D005387:Finland; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014850:Waiting Lists