title: An evaluation of the referral process in the emergency department.
abstract: BACKGROUND
  Making an effective telephone referral is an important skill for an emergency department (ED) clinician. It is essential for patient safety that the information is conveyed in a succinct manner to the correct inpatient specialty. The aim of this study was to assess: the impact of grade of staff making the referral; specialty referred to; and condition or patient problem. It also aimed to identify current problems or barriers in the referral process.
  
  
  METHODS
  This prospective study took place in one large teaching hospital in the UK. There were two parts: data collection to obtain information on each referral made by ED staff; and questionnaires administered to obtain opinions on the current referral process from both staff making and receiving the referrals.
  
  
  RESULTS
  Data were collected over 6 days and included 362 referrals. The mean evaluation of the referral process (scored 0-4) for all referrals was 3.34 (SD 0.95). 22 ED staff responding (64.7%) felt that some specialties were more difficult to refer to than others. 60.6% of non-ED staff accepting referrals felt they would like some form of senior ED screening process prior to referral compared with 20.6% of ED staff. The most common topics commented on were communication, education and process.
  
  
  CONCLUSIONS
  There are differences in understanding and opinion between ED and non-ED staff about the referral process. There are also factors which influence ease of referral: specialty referring to and patient problem. More intervention studies are required to identify solutions that can be implemented and sustained in routine practice.
authors.affiliation: Emergency Department, Northern General Hospital, Sheffield, UK.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Croft
authors.affiliation: Emergency Department, Northern General Hospital, Sheffield, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Barnes
authors.affiliation: Emergency Department, Northern General Hospital, Sheffield, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Ginnis
authors.affiliation: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: Robin
authors.initials: R
authors.lastname: Chatters
authors.affiliation: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Mason
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D003625:Data Collection; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D011446:Prospective Studies; D012017:Referral and Consultation / Q000458:organization & administration / Q000592:standards; D013038:Specialization / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013689:Telephone; D006113:United Kingdom
keywords: Communications; Emergency care systems, emergency departments; Emergency department