title: [Improving communication between levels of health care: direct referral of patients to a one-stop service for major outpatient surgery].
abstract: OBJECTIVE
  To analyze the results obtained with a "one-stop" specialty service designed as part of a collaborative program involving primary and specialized care in order to improve communication between levels of care and reduce the delay in referral and surgical treatment for patients eligible for outpatient surgery.
  
  
  METHODS
  Prospective, descriptive, longitudinal study.
  
  
  METHODS
  Major Outpatient Surgery Unit of the Hospital Clinico San Carlos and health centers serving Health Area 7 in Madrid, central Spain.
  
  
  METHODS
  Patients more than 14 years of age with a surgical condition involving the abdominal wall, pilonidal sinus, soft-tissue tumor, or proctological disease.
  
  
  METHODS
  Direct referral, with completed preoperative work-up, of patients from health centers to the Major Outpatient Surgery Unit of the Hospital Clinico San Carlos according to a protocol developed by consensus. The patient is seen on the same day for surgical work-up and anesthesia work-up, and is given preoperative information. Patients then make only one further visit to the hospital to undergo surgery.
  
  
  METHODS
  Number of patients with each diagnosis referred, diagnostic concordance between the health center and hospital, delay from referral to surgical treatment, number of trips made for different appointments, and referral rate.
  
  
  RESULTS
  A total of 188 patients were referred. More than two thirds (68.7%) had an abdominal wall condition eligible for direct referral. Diagnostic concordance was 96%. The delay from referral until surgery was reduced by 60%, and the number of trips for appointments was reduced by 66.6%. The overall referral rate was 12.6%.
  
  
  CONCLUSIONS
  Because of its feasibility, acceptability, and cost-efficiency, the direct referral system has the potential to improve relations between primary and specialized care and enhance the quality of care by shortening the delay to treatment.
authors.affiliation: Area Sanitaria 7 de Atención Primaria, Madrid, Spain. mcerdan.hcsc@salud.madrid.org
authors.forename: M T
authors.initials: MT
authors.lastname: Cerdán Carbonero
authors.forename: R
authors.initials: R
authors.lastname: Sanz López
authors.forename: C
authors.initials: C
authors.lastname: Martínez Ramos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D003362:Cost-Benefit Analysis; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011320:Primary Health Care; D011446:Prospective Studies; D011787:Quality of Health Care; D012017:Referral and Consultation; D013030:Spain; D013997:Time Factors