title: Improving specialty care follow-up after an ED visit using a unique referral system.
abstract: OBJECTIVE
  Many patients discharged from the emergency department (ED) require urgent follow-up with specialty providers. We hypothesized that a unique specialty referral mechanism that minimized barriers would increase follow-up compliance over reported and historical benchmarks.
  
  
  METHODS
  Retrospective review of all patients requiring urgent (within 1 month) specialty referrals in 2010 from a safety net hospital ED to dermatology, otolaryngology, neurology, neurosurgery, ophthalmology, urology, plastic surgery, general surgery, or vascular surgery clinics. After specialist input, all patients received a specific follow-up appointment before ED discharge via a specific scheduling service. Necessity for payment at the follow-up visit was waived.
  
  
  RESULTS
  Of the 1174 receiving referrals, 85.6% of patients scheduled an appointment and 80.1% kept that appointment. After logistic regression analysis, the factors that remained significantly associated (P < .05) with appointment-keeping compliance were the specialty clinic type (dermatology, 61.5%, to ophthalmology, 98.0%), insurance status (other payer, 87.5%; commercial, 82.8%; Medicaid, 77.9%; Medicare, 85.7%; charity care program, 88.1%; self-pay, 73.0%), age (<18 years, 80.1%; 18-34 years, 75.0%; 35-49 years, 79.2%; 50-64 years, 85.9 %; >64 years, 93.9%), and mean length of time between ED visit and clinic appointment (kept, 10.5 days; not kept, 14.3 days). The specialty clinic (neurology, 72.8%, to vascular surgery, 100%; P < .001) was significantly associated with the likelihood of patients to complete the appointment-making process. Race/Ethnicity was not associated with either scheduling or keeping an appointment.
  
  
  CONCLUSIONS
  A referral process that minimizes barriers can achieve an 80% follow-up compliance rate. Age, insurance, specialty type, and time to appointment are associated with noncompliance.
authors.affiliation: Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202. Electronic address: fmessina@iupui.edu.
authors.forename: Frank C
authors.initials: FC
authors.lastname: Messina
authors.forename: Michele A
authors.initials: MA
authors.lastname: McDaniel
authors.forename: Adam C
authors.initials: AC
authors.lastname: Trammel
authors.forename: Denise R
authors.initials: DR
authors.lastname: Ervin
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Kozak
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Weaver
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003266:Continuity of Patient Care / Q000458:organization & administration; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008511:Medicine / Q000458:organization & administration*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010349:Patient Compliance / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult