• Göktuğ Ülkü, Nuh Çağrı Karaavcı, Çağrı Elbir, and Oğuz Kağan Demirtaş.
• Department of Neurosurgery, Etlik City Hospital, Ankara, Turkey.
• World Neurosurg. 2024 Jan 1; 181: e911e917e911-e917.

BackgroundCascading of referrals to health institutions aims to increase the balanced distribution and quality of health services provided. Although health institutions in Turkey are divided into steps in terms of scope, there is no mandatory referral system for patient application.MethodsPatients admitted to the neurosurgery outpatient clinic of 3 different hospitals in the first week of September 2023 were analyzed. The patients' complaints, reasons for referral to the outpatient clinic, by whom or by which system, the department to which they should have applied, and the necessity of the operation were examined to evaluate.ResultsThere were 671 applications made to the neurosurgery outpatient clinic in 3 different health institutions. The average examination time per patient was 6 minutes. Surgical treatment was planned for only 14.8% of the patients. Most patients were referred to physical therapy and neurology departments from neurosurgery. Only 59% of the patients came to the examination by making an appointment, while 41% were examined without an appointment. The ratio of inappropriate admissions to total admissions in these 3 health institutions was 85.1%.ConclusionsOnly a minority of patients admitted to the neurosurgery outpatient clinic at a public health institution in Turkey were found to require surgery, while the majority were referred to other outpatient clinics. This study underscores the significance of the referral chain in delivering high-quality health care services, particularly in the field of neurosurgery.Copyright © 2023 Elsevier Inc. All rights reserved.

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