title: The undivided patient: a retrospective cohort analysis of specialty referrals made from inpatient general medical units comparing regional to metropolitan practice.
abstract: BACKGROUND
  In an era of growing subspecialisation there has been significant research into the role, determinants and outcomes of outpatient referrals but very little on inpatient specialty referrals from general medical units.
  
  
  OBJECTIVE
  This study aims to describe and compare the rate of specialty referrals from inpatient general medical units in a regional general and a metropolitan tertiary hospital, and review associated outcomes.
  
  
  METHODS
  Retrospective cohort analysis of general medical admissions over the 10-week period extending from 28 March to 5 June 2011. Two hospitals were included in the study; West Gippsland Hospital (WGH) and Monash Medical Centre (MMC). For all admissions, details of patient demographics, episode of care and number of inpatient referrals made per admission were extracted from the medical records. Rates and outcomes of inpatient referrals were calculated and compared.
  
  
  RESULTS
  There were 116 admissions to MMC and 108 (107 available for analysis) to WGH during the study period. There were no significant differences in patient demographics between the two sites. However, there were significantly fewer active conditions (2.87 vs 4.01, P < 0.01), fewer specialty fields represented (2.50 vs 3.51, P < 0.01) and fewer specialty referrals made per admission at WGH compared with MMC (0.69 vs 1.74, P < 0.01). The referral rate per diagnosis and the rate of referrals per specialty field represented were significantly higher at MMC compared with WGH (P < 0.01).
  
  
  CONCLUSIONS
  This preliminary study suggests that patients admitted to rural hospital general medical units have fewer active conditions with fewer specialty referrals made per admission, compared with a comparator metropolitan hospital general medical unit. Further research is required to investigate the reasons for such differences and implications for policy and practice.
authors.affiliation: Department of General Medicine, Monash Medical Centre, Melbourne, Australia.
authors.forename: M G
authors.initials: MG
authors.lastname: Brown
authors.forename: D
authors.initials: D
authors.lastname: Campbell
authors.forename: B W
authors.initials: BW
authors.lastname: Maydom
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D003266:Continuity of Patient Care; D005260:Female; D019983:Guideline Adherence; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012423:Rural Health / Q000706:statistics & numerical data*; D014504:Urban Health / Q000706:statistics & numerical data*
keywords: general internal medicine; referral process; rural medicine