Table 4. Items associated with reporting more diagnostic difficulty.

Information Processing Item

Incomplete, missing, or illegible documentation*

Test result tracking system that fails to let me know when test results are available

Not receiving ED discharge summaries or consult notes when my patients have been seen in the ED or by another service

Insufficient time for me to integrate the volume of clinical information (e.g., labs, test results) I receive*

Insufficient time for me to think carefully about diagnostic issues*

Referral Scale Item

Specialists return referrals with requests for additional information*

Test results or diagnostic information but no recommendation for next steps from the specialist who has done the consult*

Unclear understanding between specialists and me concerning who is responsible for informing and treating patients when abnormal test results are reported*

Unclear understanding when a specialist should refer a patient to another specialist rather than back to me*

Long wait times for specialty care consult appointments*

Specialists deny referrals*

Specialists not responding to my calls or e-mails in a timely manner*

Responses: 1=All of the time, 2=Most of the time, 3=Some of the time, 4=A little of the time, 5=None of the time

^*P for difference in response for those reporting more frequent vs. less frequent diagnostic difficulty<0.01