title: Communication breakdown in the outpatient referral process.
abstract: OBJECTIVE
  To evaluate primary care and specialist physicians' satisfaction with interphysician communication and to identify the major problems in the current referral process.
  
  
  METHODS
  Surveys were mailed to providers to determine satisfaction with the referral process; then patient-specific surveys were e-mailed to this group to obtain real-time referral information.
  
  
  METHODS
  Academic tertiary care medical center.
  
  
  METHODS
  Attending-level primary care physicians (PCPs) and specialists.
  
  
  RESULTS
  The response rate for mail surveys for PCPs was 57% and for specialists was 51%. In the mail survey, 63% of PCPs and 35% of specialists were dissatisfied with the current referral process. Respondents felt that major problems with the current referral system were lack of timeliness of information and inadequate referral letter content. Information considered important by recipient groups was often not included in letters that were sent. The response rate for the referral specific e-mail surveys was 56% for PCPs and 53% for specialists. In this e-mail survey, 68% of specialists reported that they received no information from the PCP prior to specific referral visits, and 38% of these said that this information would have been helpful. In addition, four weeks after specific referral visits, 25% of PCPs had still not received any information from specialists.
  
  
  CONCLUSIONS
  Substantial problems were present in the referral process. The major issues were physician dissatisfaction, lack of timeliness, and inadequate content of interphysician communication. Information obtained from the general survey and referral-specific survey was congruent. Efforts to improve the referral system could improve both physician satisfaction and quality of patient care.
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: T K
authors.initials: TK
authors.lastname: Gandhi
authors.forename: D F
authors.initials: DF
authors.lastname: Sittig
authors.forename: M
authors.initials: M
authors.lastname: Franklin
authors.forename: A J
authors.initials: AJ
authors.lastname: Sussman
authors.forename: D G
authors.initials: DG
authors.lastname: Fairchild
authors.forename: D W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D000553:Ambulatory Care; D001900:Boston; D003142:Communication; D003625:Data Collection; D019538:Health Care Surveys; D006801:Humans; D007588:Job Satisfaction; D008511:Medicine / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D012017:Referral and Consultation; D013038:Specialization; D011795:Surveys and Questionnaires