Introduction: Between 2009 and 2010, LAC/USC received 43,000 requests for outpatient referrals from outside clinics and hospitals. Neurosurgery received over 1200 requests for outpatient services between 2009 and 2010. The clinic sees 80 patients per week and patient wait times for a clinic appointment can exceed 6 months. In addition, patients often wait hours at clinic to be seen. In an attempt to reduce wait times, a clinic referral system was used to pre-screen referrals. In this study the demographics of outpatient referrals at LAC/USC were reviewed in order to characterize the outpatient population in hope to improve quality of care within the outpatient system.
Methods: The study included all new referrals of patients throught Los Angeles County's Referral Processing System between September 2010 and October 2010. One neurosurgical attending surgeon reviewed all records. Data was collected on: 1)Reason for referral 2)Symptoms and exam 3)Available imaging 4) Findings on Imaging 5) Referral acceptance or denial 6) Reason for denial.
Results: 236 patient referrals were reviewed. Only 37 patients (15.6%) had appropriate neurosurgical indications for referral. 130 out of 236 (55%) patients were referred for lower back pain. 8 out of the 130 lower back pain patients were approved as appropriate referrals with the remaining being denied for two primary reasons: 1.lack of any neurologic exam, and 2. lack of a correlating lesion on MRI that would warrant a surgical referral.
The second most common referral was for neck pain: 26 of 236 (11%) patients. Only 3 out of 26 were appropriate surgical referrals.
Conclusions: A referral processing system can identify patients who are inappropriately referred. It also can provide a basis for feedback and guidelines for primary care providers, thereby reducing inappropriate patient referrals and improving efficiency in a resource-limited setting.
Patient Care: Screening referrals results in fewer unnecessary visits and less neurosurgeon time wasted with patients they cannot help.
Learning Objectives: Describe the most common reasons patients are inappropriately referred to neurosurgery clinic.
Explain how screening referral requests can result in increased clinic efficiency and patient satisfaction.