Paediatrician perceptions of patient referral and discharge

Abstract

Objective The aim of the present study was to determine the factors involved in the decision of paediatric specialists to discharge patients back to their primary care provider following referral. Return of patients to primary care, when medically appropriate, is essential to provide efficient care to children given the limited workforce of paediatric subspecialists in Australia.

Methods Data were compiled from a self-completed mail survey of all paediatricians in five specialties at two children’s hospitals in Melbourne (n = 81). Analysis involved frequency distributions and descriptive analyses, followed by bivariate analyses to determine the differences, if any, among respondents based on the demographic variables collected.

Results The response rate was 91%. Most paediatricians (73%) believed that at least sometimes referrals were for a condition general practitioners (GPs) should be able to manage themselves. However, only 36% reported that they frequently or almost always provided the referring GP with information on how to care for the particular condition without a referral. Concerns regarding whether a patient would receive required care following discharge were felt to be important by most paediatricians. Further, many paediatricians reported that their discharge decision is affected by concerns it would be too complicated to arrange for a GP to take over the care of a patient.

Conclusions Understanding the factors involved in the referral process and the decision to discharge patients from speciality care clinics to primary care is essential to develop strategies to address long waiting times. Ensuring appropriate referral of children involves the participation of GPs, parents and specialists.

What is known about the topic? Most paediatric subspecialists practice in paediatric hospitals, where there is a sufficient volume of patients requiring their services. There have been reports across Australia of increased referrals to general and subspecialist paediatricians, with subsequent increases in waiting times and difficulties accessing timely care for children. There are anecdotal reports of inappropriate referrals to paediatric subspecialty clinics.

What does this paper add? There is broad sentiment among paediatric specialists that they receive many referrals from GPs without either a clear rationale for the referral and/or sufficient information regarding the clinical history of the patient. Few paediatricians report contacting the referring GP to obtain additional information. Paediatricians believe parents are a frequent driver of both necessary and unnecessary referrals.

What are the implications for practitioners? Understanding the factors involved in the referral process and the decision to discharge patients from speciality care clinics to primary care is essential to develop strategies to address long waiting times.