Referral of discharged emergency department patients to primary and specialty care follow-up

Abstract

Background: Emergency department (ED) patients often need urgent primary or specialty care follow-up, but access is particularly difficult for those without insurance.

Objective: To characterize follow-up options for uninsured ED patients and to evaluate differences based on ED characteristics.

Methods: We mailed a survey to all ED Directors in Colorado, Georgia, Massachusetts, and Oregon (n = 351 EDs). Typical referrals for urgent primary and specialty care follow-up for uninsured patients were classified as: a) private physician or clinic affiliated with the same hospital; b) external public clinic or university hospital; or c) no referral system/policy.

Results: Of the 298 (85%) responding EDs, 215 (72%) reported primary care referral to private physicians or clinics at the same hospital and 231 (78%) for specialty care. Twenty (7%) and 27 (9%) EDs had no referral system for primary and specialty care, respectively. Factors associated with typical referral to primary care follow-up at the same hospital were: lower visit volume (85% for EDs with < 1 patient per hour vs. 67% for EDs with ≥ 3 patients per hour); rural area (79% for rural vs. 68% for urban areas), and critical access hospital status (81% critical access vs. 69% non-critical access). Conversely, higher visit volume (87% vs. 58%), urban (81% vs. 72%), and non-critical access hospitals (83% vs. 53%) were more likely to refer for specialty care follow-up at the same hospital.

Conclusion: Referral of uninsured ED patients to local follow-up was high for primary and specialty care. Smaller, rural EDs referred within their own hospital more often for primary care but less often for specialty care.