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Eadington, D. W. "Delayed referral for dialysis." Nephrology Dialysis Transplantation 11, no. 11 (November 1, 1996): 2124–26. http://dx.doi.org/10.1093/oxfordjournals.ndt.a027123.
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ÇAVUŞOĞLU, Y. Hakan, Ayşe KARAMAN, İbrahim KARAMAN, Derya ERDOĞAN, and İsmet Faruk ÖZGÜNER. "Delayed Referral of Congenital Anomalies." Turkiye Klinikleri Journal of Medical Sciences 32, no. 3 (2012): 745–49. http://dx.doi.org/10.5336/medsci.2011-26349.
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Sengar, Mamta, Yousuf Siddiqui, Alisha Gupta, and Anup Mohta. "Delayed referral for orchidopexy: Scrutinising the causes." Tropical Doctor 52, no. 1 (December 17, 2021): 27–29. http://dx.doi.org/10.1177/00494755211044614.
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Orchidopexy for undescended testis is recommended at a younger age than heretofore; our study aimed to assess delays, and their causes, by retrospective analysis of data from a single tertiary care centre over one year (2015–2016). Almost 80% of children were brought after 1 year of age, mostly because of delayed referral by primary physicians (60%), or missed diagnosis by parents or primary physicians (20%). Misconception about the risk of surgery below 1 year was significant (15%). A timely referral is encouraged.
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Jerónimo, Teresa, Anabela M. Guedes, André Fragoso, Ana Pimentel, Sandra Sampaio, Ana P. Silva, Viriato Santos, Idalécio Bernardo, and Pedro L. Neves. "FP350THE ECONOMIC BURDEN OF DELAYED NEPHROLOGY REFERRAL." Nephrology Dialysis Transplantation 30, suppl_3 (May 2015): iii185. http://dx.doi.org/10.1093/ndt/gfv175.32.
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Aklilu, Tamirat Moges. "Referral pattern of children with cardiac diseases: a cross-sectional review of referral documents in three teaching hospitals in Addis Ababa." Ethiopian Journal of Pediatrics and Child Health 17, no. 2 (December 28, 2022): 78–92. http://dx.doi.org/10.4314/ejpch.v17i2.2.
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Background: Patients with hemodynamically significant structural heart lesions often become inoperable if early referral and intervention is not done. Contrarily, referring patients with hemo-dynamically-insignificant lesions congest the already busy tertiary centers. The study aim was to determine the proportion of hemodynamically significant cases with delayed presentation and their determinant factors.
Methods: A cross-sectional study design was used to collect data from 369 referral slips sampled using a single population proportion formula (95% CI, 5% margin of error, and 50% cases coming with a referral paper). Data was analyzed using SPSS software package version 25. Binary logistic regression analysis was done to determine factors associated with referral either to the Tikur Anbessa hospital versus Saint Paul and Yekatit 12 hospitals. Odds ratio with their corresponding confidence interval was used to assess the significance of association and statistically significant associations were declared at p-value < 0.05.
Result: The overall magnitude of delayed presentation beyond 1 year of age among patients with hemodynamically-significant lesions was 54%. Saint Paul and Yekatit-12 hospitals combined had higher referral from primary institutions (AOR=2.68 95% CI-1.64-4.38, p<0.001). Tikur Anbessa hospital had higher referral of congenital heart disease and retention of feedback referral slips compared to the two hospitals (AOR=1.86, 95% CI-1.02-3.41, p=0.004) and (AOR=2.78, 95% CI-1.65-4.69, p<0.001). If the referring health worker was a specialist, and initial symptom was chronic and poly, the likely-hood of being referred to Tikur Anbessa Specialized hospital was higher (AOR=10.34, 95% CI-2.20-48.69, p=0.003) and 1.97, 95% CI-1.21-3.22, p=0.007) respectively. The time lapse between referral and reaching at the referral destination was longer in cases referred to TASH (AOR=2.91,95% CI-1.74-4.88), p<0.001). Feedback slips were sent back to the referring health facilities in only 3% of cases.
Conclusion: Delayed presentation of patients with hemodynamically significant cardiac lesions was tremendous. and unsent or retained feedback referral slips were significant. Future research should focus on active searching for causes of delayed presentation using a well-designed and validated tool.
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Zammit, Marthaclaire, Jackline Nyaberi, Susan Mambo, and Careena Otieno. "A hospital-based survey assessing the health facility-level factors that contribute to delayed diagnosis of cervical cancer; patients views." Open Research Europe 4 (August 13, 2024): 175. http://dx.doi.org/10.12688/openreseurope.17697.1.
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Background In Kenya, Cervical Cancer is the 2nd commonly diagnosed type of cancer and the leading cause of cancer-related death among women. Globally, more than 50% of Cervical Cancer diagnoses are made late, with this proportion rising to 80% in developing countries. Poor Health systems can cause delays in diagnosis; thus, this study focused on determining the health facility level factors that contribute to delayed diagnosis among Cervical Cancer patients at Kenyatta National Hospital (KNH). Methods An analytical cross-sectional mixed method study was adopted to collect data on hospital and referral experiences from 139 Cervical Cancer patients systematically sampled at the KNH, using a semi-structured questionnaire. Associations between stage at diagnosis and hospital and referral experience were tested using a logistic regression model at a 95% Confidence Interval. Results 86 (61.9%) patients were diagnosed with advanced stages III and IV. The potential predictors for delayed diagnosis were a higher number of hospital referrals (p =0.000), facing referral challenges (p =0.041), longer time taken for diagnosis appointment (p =0.059), and longer time taken for diagnostic results (p =0.007) in the bivariate analysis. A higher number of hospital referrals (p =0.001) and longer time taken for diagnostic results (p =0.025) were significantly associated with delayed diagnosis of cervical cancer in the multivariate logistic regression test model. Referral challenges include misdiagnosis, cost of diagnosis, and prolonged diagnosis appointments. The study concluded that the advanced stage at presentation for most patients was due to poor health and referral systems, inadequate medical personnel, and diagnostic equipment. Conclusion This study recommends improving referral systems and encouraging partnerships to decentralize diagnostic centers and equipment and to train more experts on Cervical Cancer.
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Sved, Paul D., Michael K. Morgan, and Neville C. Weber. "Delayed referral of patients with aneurysmal subarachnoid haemorrhage." Medical Journal of Australia 162, no. 6 (March 1995): 310–11. http://dx.doi.org/10.5694/j.1326-5377.1995.tb139907.x.
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Trevathan, E., and F. Gilliam. "Lost years: Delayed referral for surgically treatable epilepsy." Neurology 61, no. 4 (August 25, 2003): 432–33. http://dx.doi.org/10.1212/wnl.61.4.432.
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Cass, Alan, Joan Cunningham, Paul Snelling, Zhiqiang Wang, and Wendy Hoy. "Urban disadvantage and delayed nephrology referral in Australia." Health & Place 9, no. 3 (September 2003): 175–82. http://dx.doi.org/10.1016/s1353-8292(02)00037-0.
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A, Cass, Cunningham J, Snelling P, Wang Z, and Hoy W. "DELAYED REFERRAL WORSENS LONG-TERM SURVIVAL ON DIALYSIS." Nephrology 7, no. 1 (February 2002): A109. http://dx.doi.org/10.1046/j.1440-1797.2002.00007-1-109.x.
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Tanco, Kimberson, David Hui, Sun Hyun Kim, Jung Hye Kwon, Tao Zhang, Jung Hun Kang, Wadih Rhondali, et al. "Predictors of palliative care (PC) referral for advanced cancer patients." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e19613-e19613. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e19613.
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e19613 Background: We previously examined factors associated with delayed PC referral. Little is known about the actual proportion of patients referred to PC. We determined the proportion of patients who had a PC consultation at our cancer center and the predictors of referral. Methods: All adult patients in the Houston area who died of advanced cancer between 9/1/2009 and 2/28/2010 while under the care of our institution were included. We collected baseline demographics and data on PC referral. Multivariate logistic regression was used to examine factors associated with PC referral. Results: 386/912 (42%) decedents had a PC referral, and 179 (46%) were seen initially as outpatients. In multivariate analysis, PC referral was associated with younger age (odds ratio (OR) 0.98 per year; 95% confidence interval (CI) 0.97-0.99; P<0.001), married status (OR 1.5; 1.1-2.0; P=0.005), and gynecologic cancer (OR 1.9, 1.1-3.5, P=0.02 relative to lung). Among patients with a PC referral, outpatient consultation was more likely among patients with head and neck cancer (OR=5.5, 1.7-17.6, P=0.004 relative to lung). In contrast, hematologic malignancy was associated with decreased PC referral (OR=0.59, 0.36-0.97, P=0.04), fewer outpatient PC consultations (OR=0.3, 0.1-0.7, P=0.01) and less time from referral to death (Table). Conclusions: Younger, married patients and those with gynecologic cancer were more like to be referred to palliative care. Head and neck cancer patients were more often seen as PC outpatients. Patients with hematologic malignancies had fewer PC referrals and often late in the disease trajectory compared to patients with solid tumors. [Table: see text]
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Heky, Albar, Budi Prasetyo, Hanifa Erlin Damayanti, and Lilik Djuari. "Epidemiological description of the risk factors for obstetric emergencies in cross-referral cases at Dr. Soetomo Regional Public Hospital during the COVID-19 pandemic from 2020 to 2021." Bali Medical Journal 12, no. 3 (October 9, 2023): 2992–3000. http://dx.doi.org/10.15562/bmj.v12i3.4834.
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Link Of Video Abstract: https://youtu.be/zIVTZc6xl_8 Introduction: Emergency obstetric referrals are crucial for preventing pregnancy complications that may escalate into severe, life-threatening conditions, ultimately resulting in fatalities. The pandemic influenced the obstetric referral system of healthcare services. Specifically, Dr. Soetomo Regional Public Hospital recorded 107 cross-referral cases in 2020 and 58 in 2021 with obstetric risk factors. In this study, we analyze these obstetric emergency cross-referral cases during the pandemic at the hospital. This study aims to provide an epidemiological description of cross-referral cases with risk factors for obstetric emergencies at Dr. Soetomo Regional Public Hospital during the COVID-19 pandemic from 2020 to 2021. Methods: An analytical descriptive research design, employing a case study approach, was used to analyze cross-referral cases with risk factors for obstetric emergencies over the pandemic period. The research subjects encompassed all obstetric emergency cross-referral cases at Dr. Soetomo Regional Public Hospital during the pandemic, with a total sampling technique applied to select cases that met specific inclusion and exclusion criteria. Results: The analysis of emergency obstetric referrals revealed a significant relationship between the patient’s age and their risk factor categories for obstetric emergencies (p < 0.001). Furthermore, a significant correlation was found between the delayed referral phases and the risk factors for obstetric emergencies (p < 0.001). A significant correlation was observed concerning the need for Intensive Care Unit (ICU) care. The analysis also demonstrated a significant relationship between obstetric emergencies and birth weight as well as APGAR score (p < 0.05). Conclusion: This study reveals a compelling relationship between the risk factors for obstetric emergencies and the variables such as age, methods of vaginal delivery, delayed referral phases, birth weights, and APGAR scores during the COVID-19 pandemic.
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Chan, Angela, Ryan Woods, and Sharlene Gill. "Factors associated with delayed time to adjuvant chemotherapy (AC) in stage III colon cancer: British Columbia Cancer Agency (BCCA) cohort experience." Journal of Clinical Oncology 30, no. 4_suppl (February 1, 2012): 574. http://dx.doi.org/10.1200/jco.2012.30.4_suppl.574.
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574 Background: The current standard for resected stage 3 colon cancer after surgical resection is adjuvant 5FU-based chemotherapy. In trials, AC is mandated within 8 weeks after surgery, but outside the trial setting, up to 19% of patients do not receive treatment within 8 weeks. A recent meta-analysis confirms that AC started more than 8 weeks after surgery results in significantly decreased overall survival. Our objective was to ascertain logistical and patient factors associated with delayed AC delivery (defined as >56 days from surgery) in referred patients with resected stage 3 colon cancer. Methods: A population-based cohort of patients diagnosed with stage 3 colon cancer between January 2008 to December 2009 referred to the BCCA and treated with at least one cycle of AC were identified. Patient characteristics, and time intervals between surgery, referral, medical oncology consultation (MOC) and AC were assessed. Differences in patient characteristics and time intervals between patients were assessed using the Chi-square and Wilcoxon Rank-sum tests. Results: Median time from surgery to AC was 58 days with 54% of patients receiving AC beyond 56 days. Temporal differences were identified in all intervals between the between the timely and delayed groups (see table 1). Referral was most commonly initiated after hospital discharge. The only patient factors associated with delayed initiation included poorer ECOG status and being treated at the most urban centre within BCCA. Age, gender, comorbidity index, T stage and tumour location were not different between the groups. Conclusions: 54% of patients with stage 3 colon cancer had a delayed AC initiation. Process related delays at each step of the referral process need to be addressed including timely referral, MOC triage and addressing chemotherapy waitlists. [Table: see text]
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Patterson, Mark E., Paul Chan, Susan Melton, Tracie Breeding, Stacy Farr, and John Spertus. "203 Implementing a hospital-based referral system to connect heart failure patients with payer disease management: approaches and lessons from a pilot study." Journal of Clinical and Translational Science 6, s1 (April 2022): 30. http://dx.doi.org/10.1017/cts.2022.105.
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OBJECTIVES/GOALS: Commercial health insurance payers invest in disease management programs (DM) to coordinate care for complex patients. To overcome gaps in connecting patients hospitalized with heart failure to DM, we implemented a novel warm handoff referral between hospital providers and payer DM using the Implementation Research Logic Model (IRLM). METHODS/STUDY POPULATION: A research and quality improvement team collaborated with champions from one hospital and three payers to build and pilot an inpatient-based referral for hospitalized patients with heart failure who were beneficiaries of one of three payers. The standard process of payers initiating contact with patients by phone was restructured to enable inpatient teams to initiate referrals by screening eligible patients prior to discharge. Between August 2020 and October 2021, 285 patients were hospitalized and eligible for screening. Patient registries were built to track patient referral, eligibility, and enrollment status. Monthly stakeholder meetings were used to collect referral rates and review barriers and facilitators related to implementation. RESULTS/ANTICIPATED RESULTS: Of the 63.6% (N=168) patients screened, 31.4% (N=83) were referred, 17.4% (N=46) declined referral, and 14.8% (N=39) were deemed ineligible by payers. Inpatient screenings were challenged by variability across five units with incomplete/missed referrals, primarily attributed to COVID-19-related staff shortages. Payers were challenged by delayed/incomplete referrals and varying access to the hospitals EHRs. Building patient registries helped inpatient champions track eligibility and referral status, and centralizing screening to one champion improved screening rates and reduced incomplete referrals. Additional challenges being addressed include clarifying each payers unique eligibility requirements, refining payers review of referral emails, and creating descriptions of DM for patients. DISCUSSION/SIGNIFICANCE: Implementing inpatient-based DM referrals requires patient and staff engagement, real-time data sharing, and iterative process improvement. Referrals using robust health IT systems could improve patient engagement by connecting payers, providers, and patients; and improve evaluation efforts with real-time process and outcome data.
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Silmy, M. B. M., M. A. M. Hilmy, and A. F. F. Ashmah. "A Study on Antenatal Clinic Referrals of Medical Officer of Health Office, Navithanveli." Batticaloa Medical Journal 18, no. 2 (December 27, 2024): 3–7. https://doi.org/10.4038/bmj.v18i2.45.
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Introduction: Timely referrals are crucial for improving maternal and child health, as delays can have adverse consequences. Understanding the factors affecting referrals is essential for improvement.Objectives: To assess the timeliness and outcomes of referrals from antenatal clinics, and to identify the factors influencing the outcomes.Methodology: This retrospective descriptive study reviewed data from 39 referrals made in the last quarter of 2023 at the Medical Officer of Health Office Navithanveli, Sri Lanka. Data sources included patient records, referral books, and semi-structured interviews with healthcare providers.Results:• Referral timing: Most referrals (66.7%) were made in the third trimester.• Patient characteristics: The majority of mothers were aged 20-35 years, studied up to Ordinary Level, and were accompanied by a person to the clinic.• Referral reasons: The most common reasons were anemia (28.2 %), high blood pressure and fundal height issues.• Referral outcomes: Two-thirds of mothers reached the hospital on time. Others went to private care, delayed seeking care, or refused referral.• Reasons for delay: Transport/financial barriers (38.4%) and lack of a companion (23%) were the main reasons for delay or not seeking care.Conclusion: While most referrals were timely, there is room for improvement. Transport and financial problems, and lack of a companion were key barriers.
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Tsirlis, T., F. Ausania, SA White, JJ French, BC Jaques, RM Charnley, and DM Manas. "Implications of the Index Cholecystectomy and Timing of Referral for Radical Resection of Advanced Incidental Gallbladder Cancer." Annals of The Royal College of Surgeons of England 97, no. 2 (March 2015): 131–36. http://dx.doi.org/10.1308/003588414x14055925060073.
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IntroductionAdvanced (pT2/T3) incidental gallbladder cancer is often deemed unresectable after restaging. This study assesses the impact of the primary operation, tumour characteristics and timing of management on re-resection.MethodsThe records of 60 consecutive referrals for incidental gallbladder cancer in a single tertiary centre from 2003 to 2011 were reviewed retrospectively. Decision on re-resection of incidental gallbladder cancer was based on delayed interval restaging at three months following cholecystectomy. Demographics, index cholecystectomy data, primary pathology, CA19–9 tumour marker levels at referral and time from cholecystectomy to referral as well as from referral to restaging were analysed.ResultsThirty-seven patients with pT2 and twelve patients with pT3 incidental gallbladder cancer were candidates for radical re-resection. Following interval restaging, 24 patients (49%) underwent radical resection and 25 (51%) were deemed inoperable. The inoperable group had significantly more patients with positive resection margins at cholecystectomy (p=0.002), significantly higher median CA19–9 levels at referral (p=0.018) and were referred significantly earlier (p=0.004) than the patients who had resectable tumours. On multivariate analysis, urgent referral (p=0.036) and incomplete cholecystectomy (p=0.048) were associated significantly with inoperable disease following restaging.ConclusionsIn patients with incidental, potentially resectable, pT2/T3 gallbladder cancer, inappropriate index cholecystectomy may have a significant impact on tumour dissemination. Early referral of breached tumours is not associated with resectability.
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Bouillet, Benjamin, Raju Ahluwalia, Elisabetta Iacopi, José Luis Garcia-Klepzig, Claas Lüdemann, Chris Manu, Marco Meloni, et al. "Characteristics of new patient referrals to specialised diabetic foot units across Europe and factors influencing delays." Journal of Wound Care 30, no. 10 (October 2, 2021): 804–8. http://dx.doi.org/10.12968/jowc.2021.30.10.804.
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Objective: Foot ulcers are a common complication of diabetes and are associated with an increase in lower limb amputation and death. Early referral to a specialised unit is recommended. The aim of this study was to assess the characteristics of new-patient referrals to specialised diabetes foot care units across Europe and to determine the factors involved in delayed referral. Method: In this prospective observational study, consecutive patients with a new foot ulcer presenting to nine diabetic foot centres in five European countries (France, Germany, Italy, Spain and the UK) were included. Results: Some 25% of the 332 patients included had presented with a foot ulcer >3 months before referral to the participating foot clinic. Compared with patients referred earlier, patients with a long time to referral (>3 months) were older (p=0.006) and had a less severe wound according to Infectious Diseases Society of America (IDSA) classification (p=0.003) and University of Texas classification (grade D=infection + peripheral artery disease, p=0.004). Conclusion: The proportion of patients with a diabetic foot ulcer (DFU) referred to a specialised unit >3 months after the beginning of the ulcer remained high throughout Europe. Patients with severe DFU were, however, referred more quickly by front line health professionals. Primary care professionals need to be made aware of the importance of early referral to a specialised unit in order to improve the management of foot disease in patients with diabetes. Declaration of interest: The authors have no conflicts of interest to declare.
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Kalra, Sanjay, Manisha Sahay, and Rakesh Sahay. "Nephrology Referral in Diabetes Practice." Journal of Social Health and Diabetes 06, no. 02 (November 12, 2018): 106–8. http://dx.doi.org/10.1055/s-0038-1675650.
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AbstractDiabetic nephropathy, including diabetic kidney disease (DKD), is a major complication of diabetes. Appropriate management of DKD requires multispecialty intervention under the guidance of endocrinology and nephrology. However, delayed referral to specialized nephrology services usually occurs, and this leads to suboptimal outcomes. This multispecialty consensus suggests simple clinical and biochemical parameters that should prompt referral of DKD patients to nephrology. A checklist for physicians who manage DKD is also provided.
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Nash, R., J. Hughes, A. Sandison, S. Stewart, P. Clarke, and A. Mace. "Factors associated with delays in head and neck cancer treatment: case–control study." Journal of Laryngology & Otology 129, no. 4 (March 19, 2015): 383–85. http://dx.doi.org/10.1017/s0022215115000687.
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AbstractBackground:Delays in head and neck cancer treatment lead to increased mortality, more extensive treatment and patient anxiety. We aim to treat all patients with cancer within 62 days of receipt of a referral. An analysis was conducted of those patients whose treatment had been delayed in order to identify factors associated with treatment delay.Methods:In this retrospective case–control study, 50 patients whose treatment was delayed were identified and compared with 50 patients whose treatment was not delayed. Individual factors assessed included patient age, co-morbidity, tumour location and stage, the treatment agreed, the hospitals to which the patients were referred, and the clinicians they saw.Results:There was a significant association between referral to a non-head and neck cancer centre, or review by a non-head and neck multidisciplinary team member, and treatment delay.Conclusion:In the context of centralisation of head and neck cancer services, it is important to consider delays that may be associated with a ‘hub and spoke’ model of service provision.
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Grant-Orser, Amanda, Charlotte Pooler, Nathan Archibald, Charlene Fell, Giovanni Ferrara, Kerri A. Johannson, and Meena Kalluri. "The diagnostic pathway for patients with interstitial lung disease: a mixed-methods study of patients and physicians." BMJ Open Respiratory Research 11, no. 1 (April 2024): e002333. http://dx.doi.org/10.1136/bmjresp-2024-002333.
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ObjectivesThe diagnostic process for patients with interstitial lung diseases (ILD) remains complex. The aim of this study was to characterise the diagnostic care pathway and identify barriers and potential solutions to access a timely and accurate ILD diagnosis.DesignThis mixed-method study was comprised of a quantitative chart review, patient and physician surveys and focus groups.ResultsChart review was completed for 97 patients. Median time from symptom onset to ILD diagnosis was 12.0 (IQR 20.5) months, with 46% diagnosed within 1 year. Time from first computed tomography (CT) scan to respirology referral was 2.4 (IQR 21.2) months. Referrals with a prior CT were triaged sooner than referrals without (1.7±1.6 months vs 3.9±3.3 months, p=0.013, 95% CI 0.48 to 2.94). On patient surveys (n=70), 51% felt that their lung disease was not recognised early enough. Commonly reported challenges to timely diagnosis included delayed presentation to primary care, initial misdiagnoses and long wait-times for specialists. Forty-five per cent of physicians (n=20) identified diagnostic delays, attributed to delayed presentations to primary care (58%), initial misdiagnoses (67%) and delayed chest imaging (75%). Themes from patient and respirologist focus groups included patient-related, healthcare provider-related and system-related factors leading to delays in diagnosis.ConclusionsThis mixed-methods study identified patient and system-related factors that contribute to diagnostic delays for patients with ILD, with most delays occurring prior to respirology referral. ILD awareness and education, earlier presentation to primary care, expedited access to chest imaging and earlier referral to respirology may expedite diagnosis.
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Blacquiere, Dylan, Michael Sharma, and Prasad Jetty. "Delays in Carotid Endarterectomy: The Process is the Problem." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 40, no. 4 (July 2013): 585–89. http://dx.doi.org/10.1017/s0317167100014712.
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Abstract:Background:Current recommendations for carotid endarterectomy (CEA) for symptomatic carotid stenosis state benefit is greatest when performed within two weeks of symptoms. However, only a minority of cases are operated on within this guideline, and no systematic examinations of reasons for these delays exist.Methods:All CEA cases performed at our institution by vascular surgery for symptomatic carotid stenosis after neurologist referral in 2008-2009 were reviewed. Dates of symptom onset, initial presentation, referral to and evaluation by neurology and vascular surgery, vascular imaging, and CEA were collected, and the length of time between each analysed. Reasons for delays were noted where available.Results:Of 36 included patients, 34 had CEA more than two weeks after symptom onset. Median time to CEA from onset was 76 days (IQR, 38-105 days). Longest intervals were between surgeon assessment and CEA (14 days; IQR, 9-21 days), neurology referral and neurologist assessment (9 days; IQR, 2-26 days), vascular imaging and referral to vascular surgery (9 days; IQR, 2-35 days) and vascular surgery referral and assessment (8 days; IQR, 6-15 days). Few patients (44.1%) had reasons for delays identified; of these, process-related delays were related to delayed vascular imaging, delayed referral by primary care physicians, or multiple conflicting referrals.Conclusions:There are significant delays between symptom onset and CEA in patients referred for CEA, with delay highest between specialist referral and evaluation. Strategies to reduce these delays may be effective in increasing the proportion of procedures performed within two weeks of symptom onset.
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Dwivedi, Seema, Monica Sahu, and Himani Malviya. "Fetomaternal outcome of referred obstetrics patients in tertiary care centre." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 13, no. 10 (September 26, 2024): 2841–46. http://dx.doi.org/10.18203/2320-1770.ijrcog20242820.
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Background: Pregnancy is a natural physiological process, with most cases being low-risk and managed safely at primary healthcare centers. However, the timely referral of high-risk pregnancies to specialized care is crucial to prevent complications and reduce maternal and neonatal morbidity and mortality. In India, particularly in rural areas, the referral system’s efficiency is vital in improving feto-maternal outcomes. Despite improvements in maternal mortality rates, the referral system faces challenges, such as poor coordination and delayed referrals, undermining further reductions in maternal mortality. This study examined the outcomes of emergency obstetric transfers to a tertiary hospital, focusing on the reasons for these transfers and the impact of specialized care on maternal and neonatal health. Methods: A retrospective observational study was conducted at GSVM Medical College, Kanpur, over a six-month period from January 1, 2024, to June 31, 2024. Data were collected on maternal and fetal demographic characteristics, clinical and obstetric conditions, and neonatal outcomes from hospital records. The study population included all obstetric cases >28 weeks referred to the department of obstetrics and gynecology. Results: Out of 2459 deliveries, 718 cases (29.2%) were referred, with the majority (78.6%) in the 21-30 age group. Most referrals were multipara (54.4%) and from district hospitals (43.8%) and CHCs (41.4%). The main reasons for referral were pre-eclampsia (13.6%), previous caesarean sections (11.4%), and anemia (12.4%). Maternal morbidity was observed in 244 cases (34%), with anemia, postpartum hemorrhage, and eclampsia being the most common complications. Maternal mortality occurred in 12 cases, primarily due to hypertensive disorders, coagulopathy, and sepsis. Among 735 births, 81.2% of babies were discharged without complications, 14.5% required NICU admission, and 4.3% were stillborn. Conclusions: Timely referral and specialized care are critical in managing high-risk pregnancies and improving maternal and neonatal outcomes. Strengthening first referral units (FRUs) and training healthcare workers are essential steps to enhance the referral system and reduce the burden on tertiary care facilities.
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Suo, E. "Heart Transplant - What is the Cost of Delayed Referral?" Heart, Lung and Circulation 30 (2021): S99—S100. http://dx.doi.org/10.1016/j.hlc.2021.06.023.
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Eadington, David W. "Delayed Referral for Dialysis: Higher Morbidity and Higher Costs." Seminars in Dialysis 8, no. 5 (October 1, 2007): 258–60. http://dx.doi.org/10.1111/j.1525-139x.1995.tb00398.x.
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Tzaribachev, N., S. M. Benseler, P. N. Tyrrell, A. Meyer, and J. B. Kuemmerle-deschner. "Predictors of delayed referral to a pediatric rheumatology center." Arthritis & Rheumatism 61, no. 10 (October 15, 2009): 1367–72. http://dx.doi.org/10.1002/art.24671.
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Janardhana, Alfryan, Besut Daryanto, and Ogi Bahaurini Gumilar. "Analysis of Factor Influencing Delayed Referral of Undescended Testis." Open Access Macedonian Journal of Medical Sciences 11, E (January 2, 2023): 76–79. http://dx.doi.org/10.3889/oamjms.2023.8649.
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BACKGROUND: The rate of delay in the referral of patients with undescended testis (UDT) to health facilities in Indonesia is still relatively high due to delays in the handling of urological surgery. Hence, it requires rapid and appropriate identification and early detection of patients with UDT in the community. AIM: The study aims to analyze the factors of delay in referral in cases of UDT management. METHODS: This study used a cohort design with a retrospective review approach to analyze various factors that cause delays in referring patients with UDT. Collecting identification was done by tracing UDT case-patient documents from January 2016 to November 2021. Data analysis used the Mann–Whitney and Chi-square comparison test, with significance achieved if the p < 0.05. RESULTS: Delay by doctors/paramedics who were not followed up, ignorance of the risk of delaying surgery, and undiagnosed UDT by parents/health-care providers showed a significant difference where the percentage of patients who were delayed was greater on these factors. In addition, the reference source is also known to have a significant difference with a significant value (p < 0.005). CONCLUSIONS: Factors that played a significant role in the delay in operative procedures for treating UDT were delays in referral from doctors (p < 0.025) (primary care physicians and pediatricians) and undiagnosed UDT conditions in patients (< 0.005).
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Gomes, Kylie M., Katharine T. Adams, Ethan Booker, and Raj M. Ratwani. "Patient Safety Risks during On-Demand Telehealth Referrals and Implications for Human Factors Research." Proceedings of the Human Factors and Ergonomics Society Annual Meeting 65, no. 1 (September 2021): 500–504. http://dx.doi.org/10.1177/1071181321651089.
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The COVID-19 pandemic has rapidly accelerated the adoptionof on-demand telehealth as a way to keep patients and providers safe from viral transmission. However, theconstrained timelines and challenging conditions under which telehealth was implemented along with the factthat many patientsand providers are interacting in a new modality raisesconcerns about the potential for unintended patient safety risks that have yet to be fully understood. With the surge in telehealth patient volumeduringthe pandemic,on demand telehealth has served as a way to triageand refer patients who need additional in-person evaluation and treatment. One safety concern is whether patients who are referred are successfully following through on in-person care referrals as thefailure to seekin-person care may lead to increased risk of delayed or missed diagnosis. This study aimsto evaluate whether patientsare successfully fulfilling their in -person referralsfollowingareferralfromon-demandtelehealth through retrospective analysis of a subset of telehealth referral datafrom a large healthcare system. Of the 911 on-demand telehealth visitswith a referral to in-person care, only 689showed anin-person care encounter following the telehealthvisit and only 75-85% ofmore immediate urgency in-person referrals were fulfilled within the recommended time period of 24 hours. This preliminary data highlights theneed for amore comprehensiveanalysisof the telehealth referral processand the application of human factors methodsto understand and address barriers and risks associated with telehealth referrals and successful follow up.
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Thomas, M., K. Cookson, R. Clark, L. Pearce, J. Fox, and A. Price. "472 A PILOT COLORECTAL AND GERIATRIC MEDICINE (CGM) CLINIC FOR OLDER, FRAIL PATIENTS REFERRED VIA A 2 WEEK WAIT PATHWAY." Age and Ageing 50, Supplement_2 (June 2021): ii8—ii13. http://dx.doi.org/10.1093/ageing/afab116.08.
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Abstract Introduction The two week wait (2ww) colorectal referral pathway was introduced to expedite referrals where cancer is suspected, facilitating prompt diagnosis +/− intervention. Older frail patients are referred via this 2ww pathway even when invasive testing and intervention may not be appropriate. These patients may benefit more from holistic assessment than a universally surgical approach. A Colorectal and Geriatric Medicine (CGM) 2ww referral clinic was piloted, delivered by an urgent referral colorectal specialist nurse and an advanced clinical practitioner in geriatric medicine. Method Patients >65 years with a Clinical Frailty Scale (CFS) score of 5 or more at referral were directed to the CGM clinic. A telephone consultation was undertaken, incorporating both 2ww assessment and aspects of comprehensive geriatric assessment. Results 42-patients were reviewed in the clinic. Mean age was 86.1 years and mean CFS 6. 12-patients underwent CT, and 2 CT virtual colonoscopy. No patients underwent endoscopic investigation and 28-patients declined any investigation. Of those who underwent investigation, no cancers were identified. 1 patient was referred on for endosocpic mucosal resection of polyps. 5-patients had severe diverticular disease, which accounted for their symptoms. Medication recommendations were made for 30-patients, some of which led to symptom cessation. Onward referrals were made to a community geriatrician, diabetes and continence teams, and palliative care specialists. 9-patients were identified as meeting criteria for advance care planning. This was commenced during the consultation and communicated back to the referring clinician for further action. Conclusion Older, frail patients are often not able, nor wish to undergo, invasive investigations but should not be disadvantaged or delayed in their pathway. Further work is needed to determine the most appropriate referral pathway for this group of patients. Holistic assessment that leads to improvement in symptoms and future planning may not be achievable through a solely surgical assessment.
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Agede, Olalekan A., and James A. Ogunmodede. "Evaluation of referral letters to the antiretroviral therapy outpatient specialist clinic of the tertiary health facility in Ilorin, Nigeria." Tropical Journal of Health Sciences 29, no. 4 (November 27, 2022): 20–25. http://dx.doi.org/10.4314/tjhc.v29i4.4.
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Human immunodeficiency virus (HIV) disease is a chronic medical condition that requires lifelong treatment. Specialist care is of importance in its management and referral process to a specialist is mostly initiated through a referral letter. The ability to design a good management plan during consultation depends on the quality of clinical information in the referral. This study was designed to assess the information provided in referral letters presented to Antiretroviral Therapy (ART) outpatient specialist clinic in a tertiary hospital in Nigeria
It was a retrospective study conducted between January and June 2022. All referral presented to ART clinic on clinic days were reviewed for information provided using a data capture form.
A total of 142 referrals were analyzed. The majority of the referral provided information on patient identifiers. Information on clinical parameters considered important for quality review and management were generally unsatisfactory. Less than a quarter of the referral provided information on laboratory investigations like cluster of differentiation 4 count. Majority (97.9%) of the referrals stated the reason for the referral but physical examination findings and medication history were only reported in 38.7% and 43% respectively.
Referral letters to ART clinic were deficient in the information needed for quality review. The deficiencies delayed patient management. Institution of measures to address the deficiencies will help to improve HIV care. The use of a structured referral form and training of doctors on the required information in a referral letter will also impact positively on HIV care.
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Hampton, Chelsey, Bridie Evans, Khalid Ali, Jenna Bulger, Gary Ford, Chris Moore, Alison Porter, et al. "PP085 A Scoping Review Of Emergency Assessment And Referral Of Suspected Transient Ischemic Attack." International Journal of Technology Assessment in Health Care 33, S1 (2017): 110–11. http://dx.doi.org/10.1017/s0266462317002537.
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INTRODUCTION:Patients who experience Transient Ischaemic Attack (TIA) should be assessed and treated in a specialist clinic to reduce risk of further TIA or stroke. But referrals are often delayed. We aimed to identify published studies describing pathways for emergency assessment and referral of patients with suspected TIA at first medical contact: primary care; ambulance services; and emergency department.METHODS:We conducted a scoping literature review. We searched four databases (PubMed, CINAHL, Web of Science, Scopus). We screened studies for eligibility. We extracted and analysed data to describe setting, assessment and referral processes reported in primary research on referral of suspected TIA patients directly to specialist outpatient services.RESULTS:We identified eight studies in nine papers from five countries: 1/9 randomized trial; 6/9 before-and-after designs; 2/9 descriptive account. Five pathways were used by family doctors and three by Emergency Department (ED) physicians. None were used by paramedics. Clinicians identified TIA patients using a checklist incorporating the ABCD2 tool to describe risk of further stroke, online decision support tool or clinical judgement. They referred to a specialist clinic, either directly or via a telephone helpline. Anti-platelet medication was often given, usually aspirin unless contraindicated. Some patients underwent neurological and blood tests before referral and discharge. Five studies reported reduced incident of stroke at 90 days, from 6–10 percent predicted rate to 1.2-2.1 percent actual rate. Between 44 percent and 83 percent of suspected TIA cases in these studies were directly referred to stroke clinics through the pathways.CONCLUSIONS:Research literature has focused on assessment and referral by family doctors and ED physicians to reduce hospitalization of TIA patients. No pathways for paramedic use were reported. Since many suspected TIA patients present to ambulance services, effective pre-hospital assessment and referral pathways are needed. We will use review results to develop a paramedic referral pathway to test in a feasibility trial.
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Prendergast, C., and R. McNamara. "182 QUALITY IMPROVEMENT OF THE REFERRAL SYSTEM TO EDITH (EMERGENCY DEPARTMENT IN THE HOME) SERVICE." Age and Ageing 50, Supplement_3 (November 2021): ii9—ii41. http://dx.doi.org/10.1093/ageing/afab219.182.
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Abstract Background Our department has been providing an Emergency Department in the Home (EDITH) service since early 2020. The goal is to bring the emergency services to older people and prevent unnecessary attendances to the ED. With over 3,000 patients seen in its first 14 months, this heavily used service needs a proficient and safe referral system. The previous referral system predominately involved handwritten referrals and phone calls. Our aim was to streamline this via the introduction of the Siilo Application as a solitary referral source. A referral proforma was also drawn up to ensure all relevant details were included. Methods A baseline survey was conducted to establish staff’s opinion on the initial referral system. The questions were. 1. Are you happy with the current system of referring patients to EDITH? 2. Do you think that some referrals are being missed or delayed secondary to the current system? 3. Rank your current satisfaction with the referral system out of ten? There was also an area for feedback in the survey. The new system was then introduced using the Siilo Application. Staff were trained in its use and a referral proforma was put in place. After three months of use a second survey was conducted with the same questions. Results 60% were happy with the new referral system, up from 11% on the first survey. Those who believed referrals were being missed had fallen from 88.9% to 70%. The average score out of ten for the current system was 6.9, improved from 5.7. Conclusion Having a safe, user friendly and efficient referral system for complex patients is a fundamental part on the service we provide. Staff satisfaction with the referral system, especially in an emergency setting, is paramount to ensure adequate and safe referrals. Satisfaction rates did improve with the introduction of the Siilo Application, but there is room for further improvement.
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Fyall, Thomas, Bethany Thompson, and Ross Overshott. "A Retrospective Assessment of Referrals Between the Mental Health Liaison Team and Memory Assessment Service; Does Delayed Referral Due to Delirium Lead to Some Patients Being Lost to Follow-Up?" BJPsych Open 10, S1 (June 2024): S138—S139. http://dx.doi.org/10.1192/bjo.2024.368.
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AimsThe assessment, diagnosis, and management of memory problems in older adults are routinely undertaken by memory assessment services (MAS) typically following referral from a GP. Mental health liaison teams (MHLT) newly identify many older people in acute hospitals with memory problems. Delirium is often diagnosed acutely and should be managed prior to any consideration of dementia diagnoses, however many of these people still have histories which also suggest underlying undiagnosed dementia. Referral policies advise of 3 months delay between delirium and MAS review to avoid misdiagnosis of dementia. MHLT therefore often request GP to refer at 3 months if still indicated. It is felt that some patients may be lost to follow-up via this route; our aim was to explore this further with a view to establishing a more robust direct referral pathway if indicated.MethodsElectronic records of patients under the care of MHLT aged over 65 from June 2022 to June 2023 were reviewed. This excluded patients who were referred and discharged from MHLT after a single assessment. We collected retrospective data for 8 months during this 12-month period. For any patients with memory concerns, we recorded where MAS referral was recommended and whether they were subsequently referred and seen.Results108 patients over the age of 65 under the care of MHLT were identified. 69 patients had memory problems, 28 of whom already had established diagnoses or were already under MAS and 41 had newly identified memory problems. Of these 41 patients, 15 were felt to need MAS referral due to possible dementia. 3 were referred directly to MAS by MHLT and were seen. 5 were later referred to MAS by GP on MHLT recommendation and were seen. 7 were not later referred to MAS despite it being recommended.ConclusionAll 3 patients whom MHLT were able to refer directly to MAS were seen, whereas 7 out of 12 (58%) patients for whom 3-month delayed referral by GP was requested were not seen. The policy of 3-month delay avoids misdiagnosis due to delirium, but in practice also leaves some patients with missed opportunities for diagnosis and management of dementia. There is a need for a more robust delayed referral pathway to memory assessment services from mental health liaison teams. We hope to use these findings to improve our local referral pathways and share this information to support other localities.
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Foster, Paul W., Alastair WS Ritchie, and David J. Jones. "Prospective Analysis of Scrotal Pathology Referrals – Are Referrals Appropriate and Accurate?" Annals of The Royal College of Surgeons of England 88, no. 4 (July 2006): 363–66. http://dx.doi.org/10.1308/003588406x106540.
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INTRODUCTION Testicular cancer is a relatively uncommon, treatable condition. A general practitioner would expect to see, on average, one case of testicular cancer in the whole of their career. Benign scrotal conditions are extremely common and the source of many primary care consultations. The main patient expectations of these attendances are accurate diagnosis and adequate re-assurance as often they are the source of much anxiety and perceived embarrassment. The aim of this study was to examine the content and referral practice of primary care referral of testicular pathology and the resultant findings of the specialist practitioner. PATIENTS AND METHODS A total of 201 patients referred with scrotal pathology were prospectively analysed at the time of specialist practitioner assessment by means of data recording in a urological surgery unit and regional peripheral community clinics. RESULTS In the study group, 53 patients were referred under the 2-week rule. Of these, 9 (17%) were found to have testicular cancer. Five (36%) cancers were referred outside the 2-week rule referrals; 1 cancer was missed and 2 diagnoses delayed. In total, 44% of final clinical diagnoses differed between the referring primary care physician and the specialist practitioner. Of the 71 (35%) patients referred with a suspicion of cancer, 62 (87%) were subsequently found to be of clinically benign pathology. Overall, 80% of patients were referred more urgently than the opinion of the specialist practitioner. CONCLUSIONS Scrotal examination in the primary care setting appears to be of variable accuracy. Many patients referred with a high suspicion of cancer are found to have benign pathology. Two-week rule referrals have an acceptable positive predictive value for testicular cancer (17%). Disagreements exist in the referral priority of patients.
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Al Shamsi, Hilal Salim, Abdullah Ghthaith Almutairi, and Sulaiman Salim Al Mashrafi. "Assessing the Quality of the Saudi Healthcare Referral System: Potential Improvements Implemented by Other Systems." Global Journal of Health Science 10, no. 11 (October 13, 2018): 113. http://dx.doi.org/10.5539/gjhs.v10n11p113.
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INTRODUCTION: The referral system authorizes and transfers the responsibility for healthcare services from one provider to another. A key component of the system is the communication between primary-care and specialist providers. Poor communication between them is detrimental to and can cause significant issues with coordination of effective care.
OBJECTIVE: The purpose of this review was to evaluate current healthcare referral systems, focusing on the communication among providers, and to suggest practices that could make the Saudi healthcare referral system more effective.
DESIGN: This systematic review identified published studies of the quality of the healthcare referral system in Saudi Arabia and other countries using two databases, Medline and PubMed. Data were summarized and extracted into two tables.
RESULTS: The review included 12 studies that met its selection criteria. These studies were conducted in various regions of Saudi Arabia, but mostly the west and north. The 12 studies included 181,192 participants, with numbers of participants ranging from 21 to 138,484. The present review found that more than 50% of the referral documents and feedback reports in these studies had incomplete patient information. Implementation of electronic referrals (e-referrals) in several countries, including Australia, New Zealand and the United States, improved their referral systems, particularly by solving the problem of incomplete referral documents. In addition, the present review found that in some specialist clinics, referral cases contributed to increased workloads. One study reported on implementation of Lean Six Sigma principles in a military hospital in western Saudi Arabia, which reduced the number of referrals delayed, inappropriate referrals and the response time to referrals (7%). E-referrals and Lean Six Sigma principles may be applicable in Saudi Arabia as solutions to referral and response-time problems.
CONCLUSIONS: An increase in healthcare referrals in Saudi Arabia has caused an increase in missing essential information in referral letters and feedback reports as well as overcrowding in specialist clinics. The results of the present review suggested that implementing e-referral and Lean Six Sigma principles may improve the quality of Saudi Arabia’s healthcare referral system.
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Springer, A., C. Huber, C. A. Reck, D. Fengler, and E. Horcher. "Delayed Referral Despite Appropriate Knowledge in Cryptorchidism as a Cause of Delayed Orchidopexies in Austria." Klinische Pädiatrie 222, no. 04 (May 12, 2010): 248–51. http://dx.doi.org/10.1055/s-0030-1248260.
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Kaewsuwanna, Pinij. "Impact of a New Referral System on Time to Treatment in Referred STEMI Patients Compared With Traditional Referral System at Maharat Nakhon Ratchasima Hospital." Ramathibodi Medical Journal 46, no. 4 (December 22, 2023): 10–18. http://dx.doi.org/10.33165/rmj.2023.46.4.265319.
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Background: Acute ST-segment elevation myocardial infarction (STEMI) is an emergency condition with a high risk of death if not promptly treated with a reperfusion strategy. Delayed transfer of STEMI patients to the catheterization room is associated with poor outcomes and high mortality. The data recording and transmission system is an important factor that may help shorten the time to access treatment. Objective: To compare the time to reperfusion between 2 referral systems, the time-oriented transfer system with the traditional referral system. Methods: The retrospective study of confirmed STEMI patients within 2 distinct timeframes: May 1, 2019, to March 31, 2020, for the traditional referral system; and May 1, 2022, to March 31, 2023, for the time-oriented referral system. Patients between April 1, 2020, and April 30, 2022, were excluded due to the COVID-19 pandemic outbreak. Results: There were 330 (42.4%) patients referred through the traditional referral system, and 449 (57.6%) patients referred through the time-oriented referral system. Patients in both referral systems had comparable age and sex distributions. The Killip classification was also comparable. Patients in both referral systems were transferred from the community hospitals within comparable distance. The proportion of timely reperfusion was higher, and time to reperfusion were shorter than traditional referral system with statistically significant (median [IQR], 245 [160 - 340] and 203 [129 - 353] minutes, P < .05). Conclusions: The new referral system can reduce total ischemic and reperfusion time.
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Wong, Alfred, and Kimberley Boyle. "Old age liaison psychiatry: audit assessing adherence to referral pathway and referral characteristics including indications, interventions and outcomes." BJPsych Open 7, S1 (June 2021): S112—S113. http://dx.doi.org/10.1192/bjo.2021.330.
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AimsThis audit covered 3 hospitals in Glasgow City which has 1221 beds providing inpatient healthcare for the north east region of the city. To improve the referral process,we aimed to verify adherence to existing referral pathway and adequacy of information provided by referrals. Referral characteristics including referral indication, intervention and outcomes were accounted for to identify area interest that may help improve the referral process.MethodOur referral pathway involves completion of a Microsoft Word referral template subsequently sent electronically to an internal electronic mail.Referrals in a 2 month period were included in the audit. Each referral was reviewed for adherence to the referral template, adequacy of provided information and referral indications. Intervention in the form of staff input, Mental Health Act status, psychotropic medication prescribed and given diagnosis was ascertained via staff electronic entry records.Result139 referrals were included. 114 referrals (82%) adhered to the referral template. 72 referrals (52%) contained adequate information. Common referral indications were delirium (23%), agitation (20%), low mood (18%) and cognitive decline queries (18%). Staff input ranged from psychiatrist input (46%), liaison nurses (40%), clinical psychology (1%) and shared input (13%). 16 referrals (12%) resulted in subsequent detention under the Mental Health Act. Psychotropic medications prior to liaison assessment included antidepressants (49%), antipsychotics (29%) and benzodiazepines (16%). Liaison assessment resulted in increase use of antipsychotic (55%) and reduction of antidepressants (29%) and benzodiazepines (10%), Delirium (34%), dementia (21%), Mood & Anxiety related disorders (18%) and Query of Cognitive Impairment (14%) were recorded as the most discussed diagnosis.ConclusionReferrals with inadequate details affect the service's ability to efficiently assess for clinical urgency and matching of appropriate interventions to suit clinical needs. The percentage difference in delirium between referral indication and diagnosis highlights that delirium can be under-recognised, resulting in potentially delayed treatment. Identifying common given diagnosis and differences in psychotropic medication prescribing pattern points to the need for training and support of acute medical ward staff in utilising therapeutics for management of acute mental health disorder.A pending electronic referral pathway with mandatory entries and linked relevant online resources can encourage early recognition of acute mental health disorder and prompt early management including the use of appropriate therapeutics. An additional feature allowing direct referrals by acute ward staff to community mental health team would support continuity of care for discharged patients needing ongoing mental health assessment.
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White, Mary, and Jo-Anne Manski-Nankervis. "Delayed referral and DKA in new-onset Type 1 diabetes." Journal of Pediatrics 244 (May 2022): 250–54. http://dx.doi.org/10.1016/j.jpeds.2021.12.075.
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Sachithanandan, A., and B. Badmanaban. "Delayed surgical referral for persistent spontaneous pneumothorax : a global problem?" Interactive CardioVascular and Thoracic Surgery 12, no. 3 (February 23, 2011): 434. http://dx.doi.org/10.1510/icvts.2010.241950a.
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Carai, Andrea, Franco Locatelli, and Angela Mastronuzzi. "Delayed referral of pediatric brain tumors during COVID-19 pandemic." Neuro-Oncology 22, no. 12 (July 5, 2020): 1884–86. http://dx.doi.org/10.1093/neuonc/noaa159.
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Luu, Michael, Lynne Warner Stevenson, Richard C. Brunken, Davis M. Drinkwater, Heinrich R. Schelbert, and Jan H. Tillisch. "Delayed recovery of revascularized myocardium after referral for cardiac transplantation." American Heart Journal 119, no. 3 (March 1990): 668–70. http://dx.doi.org/10.1016/s0002-8703(05)80292-3.
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Zacharias, Victoria C., Nyingi Kemmer, Tiffany E. Kaiser, Rosann Giesting, Dilynn Russell, and Guy W. Neff. "W1874 Access to Liver Transplantation: Indirect Measures of Delayed Referral." Gastroenterology 134, no. 4 (April 2008): A—843. http://dx.doi.org/10.1016/s0016-5085(08)63941-4.
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Onnis, G., I. Dreyfus, and J. Mazereeuw-Hautier. "Factors associated with delayed referral for infantile hemangioma necessitating propranolol." Journal of the European Academy of Dermatology and Venereology 32, no. 9 (February 23, 2018): 1584–88. http://dx.doi.org/10.1111/jdv.14842.
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Cohen, Seth M., Jaewhan Kim, Nelson Roy, and Mark Courey. "Delayed Otolaryngology Referral for Voice Disorders Increases Health Care Costs." American Journal of Medicine 128, no. 4 (April 2015): 426.e11–426.e18. http://dx.doi.org/10.1016/j.amjmed.2014.10.040.
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Calisti, Alessandro, Faisal Abdelgalil Nugud, Kibreab Belay, Agnes Mlawa, and Pierluigi Lelli Chiesa. "Pitfalls and technical errors in the first approach to neonates with anorectal malformations in a non-specialist context: can we do any better? A review from three Eastern African Centres." African Health Sciences 21, no. 3 (September 27, 2021): 1340–45. http://dx.doi.org/10.4314/ahs.v21i3.45.
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Introduction: In sub-Saharan Africa, Anorectal malformations (ARM) are the most frequent cause of neonatal obstruc- tion. Referral to a Pediatric Surgeon is frequently delayed. The first treatment is often delivered at not specialist level and mismanagement may result.
Aim: To study ARM patients referred beyond neonatal period and managed at a non-specialist level.
Materials and Methods: One hundred and thirty patients were included (M/F ratio 63/67) among 144 admitted to three Eastern African Hospitals with Pediatric Surgical facilities. Demographics, type of anomaly, delay on referral, previous man- agement, most commonly observed errors are reported.
Results: The Mean age at referral was 23 months (range five weeks – 23 years). Colostomy was the most frequent surgery (92 cases). Stomas often did not follow the recommended criteria. Ten per cent were not on the sigmoid, and 35% were not divided. "Loop" or "double-barrel" colostomies did not exclude the distal loop. Inverted (10,5%), prolapsed stomas (7,5%), short distal loop (16%) were observed. Twenty-four cases (26%) needed redo. Primary perineal exploration in eight patients resulted in incontinence.
Conclusions: Investments on training practitioners, acting at District/Rural level, and closer links with tertiary centres are recommended to avoid ARM mismanagement and delayed referral to a Specialist.
Keywords: Ano rectal malformations; neonate; low resources context.
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Hadi, Ella Nurlaella. "Studi Kualitatif : Pelayanan Rujukan Asfiksia Bayi Baru Lahir di Kabupaten Cirebon Jawa Barat." Kesmas: National Public Health Journal 3, no. 3 (December 1, 2008): 133. http://dx.doi.org/10.21109/kesmas.v3i3.227.
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Pada tahun 2005, studi penatalaksanaan asfiksia bayi baru lahir (BBL) oleh bidan di desa Kabupaten Cirebon menemukan kematian asfiksia BBL yang dirujuk ke rumah sakit masih tinggi. Penelitian ini bertujuan untuk mendapatkan informasi yang mendalam tentang proses rujukan, alur penanganan rujukan kasus asfiksia BBL di RS dan kualitas pelayanan di RS rujukan Kabupaten Cirebon. Untuk itu, digunakan pendekatan kualitatif dengan metode studi kasus. Hasil penelitian menunjukkan BdD sudah menangani asfiksia BBL dengan benar, tetapi rujukan sering terlambat karena adanya faktor penghambat dari keluarga (ekonomi dan keputusan merujuk harus melibatkan keluarga besar) dan faktor lingkungan (transportasi di desa terpencil sulit terutama pada malam hari).Disamping, karena penanganan rujukan asfiksia BBL di RS belum optimal, karena masih kurangnya keterampilan petugas bagian UGD dalam manajemen asfiksia BBL dan tidak tersedianya alat resusitasi neonatus di bagian UGD, padahal prosedur penanganan kasus rujukan pertama kali di bagian UGD.Kata kunci : Pelayanan rujukan, asfiksia, BBL.AbstractIn Cirebon district (2005) research on village midwives’s experience in managing birth asphyxia showed mortality of newborns with asphyxia who were referred to the hospitals were still high. This research was aimed to assess referral process, management procedure of referral birth asphyxia cases and quality of care given in the referral hospitals. This study was conducted using qualitative approach focusing on case study method. The result of this study showed that village midwives managed birth asphyxia correctly, but referral of newborn cases was often delayed, because of community factors (finance and delayed decision making by whole family to refer the newborn to the hospitals) and environmental factor (transportation in remote villages was difficult, especially at night. Besides that, referral hospitals were not yet providing adequate emergency care for referral cases of birth asphyxia. These were primarily due to lack of skills in management of birth asphyxia and unavailability of resuscitation device in emergency room.Keywords : Referral health services, Asphyxia, newborn.
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Asranna, Ajay, Ramshekhar Menon, and Ashalatha Radhakrishnan. "Referral trends for temporal lobe epilepsy surgery between 2000 and 2014 in India." Neurology: Clinical Practice 9, no. 4 (April 9, 2019): 297–303. http://dx.doi.org/10.1212/cpj.0000000000000628.
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BackgroundWe conducted a retrospective study examining the trends in referral to a tertiary epilepsy surgery center in India over 2 decades.MethodsData of patients who underwent long-term video electro encephalography monitoring for presurgical evaluation were retrospectively analyzed. Patients aged >16 years and diagnosed to have drug-resistant temporal lobe epilepsy (TLE) were included. They were divided into 3 groups comprising 5-year periods each during which they underwent presurgical evaluation, group 1: year 2000–2004; group 2: year 2005–2009; and group 3: year 2010–2014. Referral data with particular reference to duration of epilepsy before referral, age at onset of seizures, and number of antiepileptic drugs tried before referral were analyzed.ResultsA total of 1362 patients fulfilled the inclusion criteria. There were 385 referrals in group 1, 488 in group 2, and 489 in group 3. The mean duration of epilepsy before referral was 18.10 ± 9.44 years; there was no change in the duration of epilepsy before referral (p = 0.638). A significant increase in the age at onset of seizures and age at presurgical evaluation was noted over time.ConclusionThere is evidence for delayed referral of patients with refractory TLE to a surgical epilepsy center in this study. Renewed efforts to confront challenges beholding epilepsy surgery and steps to ensure timely referral are desirable.
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Crowley, Fionnuala, Li Zeng, Tianxiang Sheng, Nadeem Bilani, Mollie Hobensack, Beth Popp, Debora Afezolli, et al. "Patterns of referral to supportive oncology (SO) practice embedded in a cancer center and impact of timing of referrals on end-of-life outcomes." Journal of Clinical Oncology 42, no. 16_suppl (June 1, 2024): e24064-e24064. http://dx.doi.org/10.1200/jco.2024.42.16_suppl.e24064.
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e24064 Background: ASCO guidelines recommend early palliative care (PC) for patients with advanced cancer, defined as within eight weeks of diagnosis, to enhance survival and quality of life. It is unclear which subsets of patients are referred “late” to PC and how timing of referral impacts cancer outcomes and end-of-life care. Methods: Patients >18 years with first SO consult between 01/01/2021-06/30/2023 were included. Data on patient demographics, acute healthcare and hospice utilization, cancer treatment and mortality was extracted from the electronic medical record (EMR) and claims database. Early referral to SO was defined as visit < 3 months after diagnosis of advanced disease, delayed referrals > 3 months and late consults as < 30 days from death. We used descriptive statistics to describe patients’ sociodemographics, clinical characteristics and healthcare utilization. Multinomial logistic regression analysis was utilized to evaluate how patient characteristics influenced the timing of referrals. To examine the effects of late referral on inpatient (IP) and intensive care unit (ICU) stay durations, we applied a hurdle model. Results: Total sample included 1229 patients; majority had ECOG < 2 and received one line of treatment at time of consult, 87% had solid tumors, of whom 74% had stage 4 disease. The solid tumors most referred were gastrointestinal cancers (25%), lung cancer (14%) and head and neck cancers (13%). Early referral rates across cancer groups differed significantly 53% Head and Neck, 48% GI, 46% Lung, 43% GYN, 29% GU, 11% Breast, and 31% Other (p < 0.001). The most common reason for referral was physical symptom management (98%). The median ESAS symptom burden was 5 (range 0-10) symptoms. At time of analysis, 431 (35.1%) patients had died of which 256 (59%) were in-hospital deaths. Of the deceased patients, late referral ( < 30 days from death) showed a trend, although not statistically significant, toward higher in-hospital mortality rates, (Odds Ratio: 1.13; 95% CI: 0.57-2.24), and a trend toward reduced likelihood of hospice enrollment(Odds Ratio: 0.73; 95% CI: 0.36-1.49). Notably, late referral significantly increased the duration of IP stays (p < 0.001) and ICU stays (p = 0.004) in last 30 days of life, without change in admission to IP (p = 0.68) or ICU (p = 0.86). Conclusions: The delivery of the guideline-directed "early” consult among patients with advanced cancer is variable. Preliminary analysis showed a trend towards higher in-hospital mortality rates and lower hospice referral for patients referred < 30 days from death among “late” consults. Further subgroup analysis is ongoing. [Table: see text]
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Iqbal, S., S. Saidullah, R. I. Ahmed, M. A. A. Khan, N. Ahmed, and M. F. Khan. "Factors Contributing to Delayed Diagnosis of Congenital Heart Disease in Pediatric Population." Pakistan Journal of Medical and Health Sciences 15, no. 5 (May 30, 2021): 1488–90. http://dx.doi.org/10.53350/pjmhs211551488.
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Objective: To analyze various factors contributing to delayed diagnosis of congenital heart disease (CHD) in pediatric population. Study Design: Cross-sectional study. Place and Duration of the Study: Department of Pediatrics and Department of Cardiology, Sheikh Khalifa Bin Zayed Al Nahyan Hospital, Rawalakot from January to December 2020. Material and Methods: A total of 265 children of both genders aged up to 15 years and presenting for the 1st time with the echocardiography confirmed diagnosis of CHD were enrolled. A special proforma was designed and questions were asked from parents/guardians of all study participants. Socio-demographic profile along with improper referral status and inadequate health facilities were noted. SPSS version 26.0 was used for statistical analysis. Qualitative variables like gender, area of residence, literacy status, socio-economic status, types of CHDs, delayed diagnosis (yes/no) and reasons for delayed diagnosis were represented as frequency and percentages. Results: In a total of 265 children included in the study, there were 156 (58.9%) male. Majority of the children, 184 (69.4%) were less than 2 years of age. Body weight below 3rd centile was noted in 164 (61.9%) children. Maternal fetal echocardiography was done in 13 (4.9%). Acyanotic CHD was noted in 180 (67.9%) children while remaining had cyanotic CHD 85 (32.1%). Delayed diagnosis of CHD was noticed in 211 (79.6%) children. Most common factor contributing to delayed diagnosis of CHD was found to be delayed 1st consultation in 85 (40.3%). Delayed or missed diagnosis by the doctor was the 2nd most frequent factor contributing to delayed diagnosis of CHD noted in 52 (24.6%) children. Delayed referrals were observed in 42 (19.9%) children. Conclusion: Delayed diagnosis of CHD was noted among 79.6% cases. Acyanotic CHD was the commonest type of CHD in the present study. Most common factors contributing to delayed diagnosis of CHD were delayed 1st consultation, delayed diagnosis by the doctor and delayed referrals. Keywords: Congenital heart disease, fetal echocardiography, delayed referrals
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Dzomeku, Veronica Millicent, Adwoa Bemah Boamah Mensah, Emmanuel Kweku Nakua, Pascal Agbadi, Joshua Okyere, Alex Kumah, Jacob Munukpa, Anthony Adofo Ofosu, Nancy Lockhart, and Jody R. Lori. "Perspectives of healthcare workers on the challenges with obstetric referrals in rural communities in Ghana: a descriptive phenomenology study." BMJ Open 13, no. 4 (April 2023): e066910. http://dx.doi.org/10.1136/bmjopen-2022-066910.
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ObjectiveWe explored and document healthcare workers’ (HCWs’) perspectives on the challenges encountered during obstetric referrals.DesignThe study adopted a qualitative research approach and a descriptive phenomenology design. HCWs permanently working in 16 rural healthcare facilities in the Sene East and West Districts composed of the target population for this study. Using a purposive sampling technique, participants were recruited and enrolled in in-depth individual interviews (n=25) and focused group discussions (n=12). Data were analysed thematically using QSR NVivo V.12.SettingSixteen rural healthcare facilities in the Sene East and West Districts, Ghana.ParticipantsHealthcare workers.ResultsAreas related to patient as well as institutional level issues challenged the referral processes. At the patients’ level, financial constraints, fears associated with referral and patients’ non-compliance with referrals were identified as challenges that delayed the referral process. With regard to institutional challenges, the following emerged: referral transportation challenges, poor attitudes of service providers, low staff strength and healthcare bureaucracies.ConclusionWe conclude that in order for obstetric referrals in rural Ghana to be effective and timely, there is the need to raise more awareness about the need for patients to comply with referral directives, through health education messages and campaigns. Given our findings on the delays associated with long deliberations, the study recommends the training of more cadre of healthcare providers to facilitate obstetric referral processes. Such an intervention would help to improve the current low staff strength. Also, there is a need to improve ambulatory services in rural communities to counteract the challenges that poor transportation system poses on obstetric referrals.