title: It Takes Two to Tango: Improving Patient Referrals from the Emergency Department to Inpatient Clinicians.
abstract: BACKGROUND
  The transfer of responsibility for patient care across clinical specialties is a complex process. Published and anecdotal data suggest that referrals often fail to meet the needs of one or both parties and that patient focus can be lost during the process. Little is known about the Australian situation.
  
  
  METHODS
  To obtain a more complete understanding of the referral process, including the nature of communication in an Australian context, we conducted semistructured interviews in a convenience sample of 25 volunteers. Two established strategies for analyzing qualitative data were used.
  
  
  RESULTS
  All respondents considered the following information essential components of a referral: an account of the patient's current condition, a working diagnosis or problem statement and history of the presenting concern, key test results or tests awaiting results, a potential management plan, and any special characteristics of the patient. Respondents acknowledged implied, if not literal, power to accept or reject an emergency department (ED) referral and said the imbalance of power was reinforced when the ED physician was junior to the inpatient clinician. Respondents also noted that in addition to the predominant organizational culture, an independent culture is associated with specific shifts. Foremost among the nonclinical aspects of a referral considered to be important was the timeliness of the contact made to achieve the transition. Respondents also said the success of a referral depended on the speaking and listening abilities of all parties. The individual's motivation to accept or reject a referral can also have an impact on communication.
  
  
  CONCLUSIONS
  Respondents attributed the difficulty of negotiating the transfer of a patient's care across the ED and inpatient interface to three distinct factors: variations in the clinical information required, the culture of the organization and of the clinical team in which the transaction takes place, and the characteristics of the individuals involved in the process. Improving communication skills has the potential to improve patient outcomes.
authors.affiliation: Emergency Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia ; The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Sean
authors.initials: S
authors.lastname: Lawrence
authors.affiliation: Emergency Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia ; The University of Queensland School of Nursing, Midwifery and Social Work, Brisbane, Queensland, Australia.
authors.forename: Lyndall M
authors.initials: LM
authors.lastname: Spencer
authors.affiliation: Emergency Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia ; The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Sinnott
authors.affiliation: Emergency Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia ; The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Eley
keywords: Emergency medicine; patient admission; patient handoff; referral and consultation