Outcomes of referrals to the ED by family physicians

Patients are commonly referred to the emergency department (ED) by family physicians (FPs). This study was undertaken to determine the outcome of these referred patients. A prospective cohort study of 196 patients referred by FPs to the ED of an urban, tertiary referral center was performed. Key outcome measures were the rate at which investigations or interventions were performed, consultation and admission rates, and the percentage of referrals that were appropriate. Comparison was made with a random cohort of nonreferred patients. Information was collected from a questionnaire completed by the emergency physician and by chart review. Eighty-six percent of patients referred to the ED had some sort of investigation or intervention performed, which was significantly higher than the 66.7% rate in nonreferred patients (P < .001). Twenty-nine percent of referred patients received a consultation in the ED compared with 16.4% of nonreferred patients (P < .01), and 16.0% were admitted to hospital compared with 10.0% in the nonreferred group (P < .10). By using the process of care method, 75.5% of referrals by FPs to the ED were appropriate. Family physicians are quite selective in their referrals to the ED. There is a high rate of admission and specialist consultation for referred patients. The vast majority of patients who are referred receive at least 1 investigation or intervention in the ED, and most referrals are appropriate.