An analysis of referrals from primary care.

he pattern and number of referrals made by primary care physicians has a significant impact on the cost and quality of health care delivery. Rationalization of the referral process leads to both savings in cost and improvement of quality of care. This paper analyzes the pattern of referrals and evaluates the effect of clinical audit on the number and type of referrals from the primary care physicians to specialists in the Northern Area Armed Forces Hospital, Hafr Al-Batin, Kingdom of Saudi Arabia (KSA) from July 2002 through to January 2003. King Khalid Military City is situated approximately 60 km west of Hafr Al-Batin in the north of KSA. It has a population of approximately 120,000 inhabitants, mainly personnel of the Saudi Armed Forces and their dependents. Other residents include civilian Saudi employees and expatriate support staff together with their families. The city has only one large hospital, Northern Area Armed Forces Hospital, run by the Ministry of Defense. This hospital has a capacity of 330 beds with daily clinics in all major specialties. The Department of Primary Care and Emergency Medicine of this hospital is staffed with 40 primary care physicians. It is headed by a consultant in Family Medicine and has 9 satellite clinics situated in various parts of the city. In the month of May 2002, a project was initiated for screening and auditing of all referrals made by the physicians of the department to the emergency room (ER) and to specialty clinics in the hospital. After a successful trial run for a period of 2-months from May through to June 2002, involving 3 family clinics, the scope of the project was widened to include all primary care clinics of the department from July 2002. The purpose of this paper is to analyze the data obtained from this project for 7-months from July 2002 through to January 2003. The present study is a retrospective analysis of the effect of clinical audit on the pattern of referrals from primary care physicians to the specialists. The study involves a cumulative total of approximately 140,000 patient visits over a period of 7-months in the Department of Primary Care and Emergency Medicine catering to a population of approximately 120,000. Referrals from primary care physicians to the hospital have been classified into 2 types. Urgent referrals constitute patients who require immediate care that may include hospitalization or emergency consultations with a specialist. Such cases are T Brief Communication